MEDICARE: OHANA MEDICAL GROUP PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208600000X	Surgery Physician
2	208D00000X	General Practice Physician
3	363A00000X	Physician Assistant
4	363LF0000X	Family Nurse Practitioner
5	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1497492706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHANA MEDICAL GROUP PLLC

Provider Business Mailing Address
First Line	:	1218 E GRAND RIVER AVE
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-1628
Country	:	US
Telephone Number	:	517-732-8877
Fax Number	:	517-659-6376

Provider Business Practice Location Address
First Line	:	1218 E GRAND RIVER AVE
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-1628
Country	:	US
Telephone Number	:	517-732-8877
Fax Number	:	517-659-6376

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY L SANDS
Credential	:	PA
Telephone Number	:	517-604-1095

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	11/09/2022

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Directions to “OHANA MEDICAL GROUP PLLC ” Practice Location

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