MEDICARE: NORTH-STAR CARE OF MICHIGAN

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	207RA0401X	Addiction Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1144024332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH-STAR CARE OF MICHIGAN

Provider Business Mailing Address
First Line	:	1368 PILCHUCK HTS
Second Line	:
City	:	FOX ISLAND
State	:	WA
Zip	:	98333-9660
Country	:	US
Telephone Number	:	855-302-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1368 PILCHUCK HTS
Second Line	:
City	:	FOX ISLAND
State	:	WA
Zip	:	98333-9660
Country	:	US
Telephone Number	:	855-302-9191
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AMANDA L WILSON
Credential	:	MD
Telephone Number	:	413-221-6113

Provider Enumeration Date	:	04/04/2025
Last Update Date	:	05/08/2025

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Directions to “NORTH-STAR CARE OF MICHIGAN ” Practice Location

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