Basic Information
| Provider Information | |||||||||
| NPI: | 1841286507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPAETH | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1185 US HIGHWAY 23 N | ||||||||
| Address2: | PO BOX 857 | ||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497078018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893564049 | ||||||||
| FaxNumber: | 9893583712 | ||||||||
| Practice Location | |||||||||
| Address1: | 1185 US HIGHWAY 23 N | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497078018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893564049 | ||||||||
| FaxNumber: | 9893583712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101018043 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1841286507 | 05 | MI | MEDICAID |