Basic Information
| Provider Information | |||||||||
| NPI: | 1790821957 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPENA MEDICAL ARTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 LONG RAPIDS RD | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497071315 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 LONG RAPIDS RD | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497071315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893542142 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | TALASKI | ||||||||
| AuthorizedOfficialFirstName: | BONNIE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | HIPAA PRIVACY OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9893542142 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | AA036532 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.