1689711772 NPI number — MYMICHIGAN MEDICAL CENTER ALPENA

Table of content: (NPI 1689711772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689711772 NPI number — MYMICHIGAN MEDICAL CENTER ALPENA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYMICHIGAN MEDICAL CENTER ALPENA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689711772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 WELLNESS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48670-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-734-4254
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2402 BRADLEY HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ROGERS CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-734-4254
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEPPERT
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
KALE
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
989-734-4254

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  5501002011 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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