1134176761 NPI number — NORTHERN MICHIGAN EMERGENCY PHYSICIANS, P.C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134176761 NPI number — NORTHERN MICHIGAN EMERGENCY PHYSICIANS, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN MICHIGAN EMERGENCY PHYSICIANS, P.C
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:
1134176761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 N DIVISION RD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PETOSKEY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49770-9046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-348-7900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 CONNABLE AVE
Provider Second Line Business Practice Location Address:
ER DEPARTMENT
Provider Business Practice Location Address City Name:
PETOSKEY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49770-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-487-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ATTIE
Authorized Official First Name:
KHALIL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
GROUP HEAD
Authorized Official Telephone Number:
231-487-4000

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CI5296 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010A510070 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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