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NPI Code Detail

MEDICARE: NORTHERN ROOTS MEDICAL ASSOCIATES P.L.L.C.

MEDICARE: NORTHERN ROOTS MEDICAL ASSOCIATES P.L.L.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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1528925971
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN ROOTS MEDICAL ASSOCIATES P.L.L.C.
Provider Business Mailing Address
First Line : 1396 DOUGLAS DR
Second Line : STE 22C
City : TRAVERSE CITY
State : MI
Zip : 49696-8981
Country : US
Telephone Number : 231-440-9956
Fax Number :
Provider Business Practice Location Address
First Line : 1396 DOUGLAS DR
Second Line : STE 22C
City : TRAVERSE CITY
State : MI
Zip : 49696-8981
Country : US
Telephone Number : 231-440-9956
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MRS. HANNAH WILSON
Credential : PA-C
Telephone Number : 231-440-9956
Provider Enumeration Date : 01/07/2026
Last Update Date : 01/07/2026

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