Basic Information
| Provider Information | |||||||||
| NPI: | 1649383837 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROGERS CITY MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 573 N BRADLEY HWY | ||||||||
| Address2: | |||||||||
| City: | ROGERS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497791508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897342171 | ||||||||
| FaxNumber: | 9897342312 | ||||||||
| Practice Location | |||||||||
| Address1: | 573 N BRADLEY HWY | ||||||||
| Address2: | |||||||||
| City: | ROGERS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497791508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897342171 | ||||||||
| FaxNumber: | 9897342312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KLINGSHIRN | ||||||||
| AuthorizedOfficialFirstName: | JENNIE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9897342171 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MSN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5010005938 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.