MEDICARE: MACKINAW CITY MEDICAL CENTER PC

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	261QP2300X	Primary Care Clinic/Center	5101013965	MI

General Provider Information

NPI Number	:	1558563981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACKINAW CITY MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	5208 LONG LAKE RD
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-9159
Country	:	US
Telephone Number	:	231-625-2010
Fax Number	:

Provider Business Practice Location Address
First Line	:	5208 LONG LAKE RD
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-9159
Country	:	US
Telephone Number	:	231-625-2010
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL HILARY FLOREK
Credential	:	DO
Telephone Number	:	231-625-2010

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	09/05/2007

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