MEDICARE: MEDICAL PRACTICE PARTNERS, LLC

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

General Provider Information

NPI Number	:	1144766965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL PRACTICE PARTNERS, LLC

Provider Business Mailing Address
First Line	:	712 S TRUMBULL ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-4211
Country	:	US
Telephone Number	:	989-893-4351
Fax Number	:	989-893-6412

Provider Business Practice Location Address
First Line	:	712 S TRUMBULL ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-4211
Country	:	US
Telephone Number	:	989-893-4351
Fax Number	:	989-893-6412

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	RETA SCHAFER
Credential	:
Telephone Number	:	989-893-4351

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	04/26/2017

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