Basic Information
| Provider Information | |||||||||
| NPI: | 1629094818 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PETOSKEY URGENT CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1890 S US HIGHWAY 131 | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497708344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314872000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1890 S US HIGHWAY 131 | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497708344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314872000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 07/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | BANYAI | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | DUANE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2314872000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 700B41015 | 01 | MI | BCBS | OTHER |