MEDICARE: PETOSKEY FAMILY MEDICINE P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301044355	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093703548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETOSKEY FAMILY MEDICINE P.C.

Provider Business Mailing Address
First Line	:	1890 S US 131
Second Line	:	SUITE 3
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8344
Country	:	US
Telephone Number	:	231-487-6000
Fax Number	:	231-487-6014

Provider Business Practice Location Address
First Line	:	1890 S US 131
Second Line	:	SUITE 3
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8344
Country	:	US
Telephone Number	:	231-487-6000
Fax Number	:	231-487-6014

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. CLAUDIA A SANTINI
Credential	:
Telephone Number	:	231-487-6000

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	08/22/2020

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