is a Adolescent Medicine in Fort Gratiot, Michigan. practices all healthcare services and medical treatments related to Adolescent Medicine. The NPI Number for is 1366554891. The last update date is .
's current location address is 3061 Commerce Dr, Fort Gratiot, Michigan. You can contact this provider via phone number 8103856663 and fax number 8103856322. The mailing address for is 3061 Commerce Dr, Fort Gratiot, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 3061 Commerce Dr, Fort Gratiot, Michigan |
| Phone Number | 8103856663 |
| Fax Number | 8103856322 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1366554891 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 3061 Commerce Dr |
|---|---|
| City | Fort Gratiot |
| State | Michigan (MI) |
| Post Code | 480593881 |
| Phone Number | 8103856663 |
| Fax Number | 8103856322 |
Provider's Primary Taxonomy Detail
| Speciality | Adolescent Medicine |
|---|---|
| Taxonomy | 207Qa0000X |
| Licence No | 4301030995 |
|
Definition: A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 4275999 | MI | CIGNA | |
| P34737F | MI | BLUE CARE NETWORK | |
| 137737 | MI | CARE CHOICES | |
| 7400172 | MI | BCBS |
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