Basic Information
| Provider Information | |||||||||
| NPI: | 1871653360 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STERLING EMERGENCY SERVICES OF MICHIGAN, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3189 SOLUTIONS CTR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606770001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048051300 | ||||||||
| FaxNumber: | 9048051302 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | DOWAGIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490471943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2697828681 | ||||||||
| FaxNumber: | 9048051302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | BUNKER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN/PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9048051300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 700A410180 | 01 | MI | BLUE SHIELD | OTHER | DF7353 | 01 | MI | RAILROAD MEDICARE | OTHER |