Basic Information
| Provider Information | |||||||||
| NPI: | 1629018494 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWOODS INTERNAL MEDICINE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3061 CHRISTY WAY | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486032267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897912455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 312 M 55 W | ||||||||
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| City: | TAWAS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487639253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893629551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 09/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | VANDERVEEN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9893629551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101011670 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.