Basic Information
| Provider Information | |||||||||
| NPI: | 1508229980 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLEVOIX PHYSICIANS CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14709 W UPRIGHT ST | ||||||||
| Address2: | |||||||||
| City: | CHARLEVOIX | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497201949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2315476519 | ||||||||
| FaxNumber: | 2315475404 | ||||||||
| Practice Location | |||||||||
| Address1: | 14709 W. UPRIGHT | ||||||||
| Address2: | |||||||||
| City: | CHARLEVOIX | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2315476519 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2016 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | TALMO | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | FAMILY PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 2315476519 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4301049260 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.