MEDICARE: SETH T. FERGUSON D O P 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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1720273634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SETH T. FERGUSON D O P C

Provider Business Mailing Address
First Line	:	PO BOX 550
Second Line	:
City	:	CARSON CITY
State	:	MI
Zip	:	48811-0550
Country	:	US
Telephone Number	:	989-584-3153
Fax Number	:	989-584-3975

Provider Business Practice Location Address
First Line	:	221 E MAPLE ST
Second Line	:
City	:	CARSON CITY
State	:	MI
Zip	:	48811-0550
Country	:	US
Telephone Number	:	989-584-3153
Fax Number	:	989-584-3975

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SETH T FERGUSON
Credential	:	D.O.
Telephone Number	:	989-584-3153

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/29/2008

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Directions to “SETH T. FERGUSON D O P C ” Practice Location

Language	Start Address	Practice Location

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