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1045 E Front St Buchanan MI 49107-8474 | |
(269) 695-5540 | |
(269) 695-0412 |
Full Name | |
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Speciality | Family Medicine |
Location | 1045 E Front St, Buchanan, Michigan |
Authorized Official Name and Position | Brenda Lee Ernsberger (OFFICE MANAGER) |
Authorized Official Contact | 2696955540 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1045 E Front St Buchanan MI 49107-8474 Ph: (269) 695-5540 | 1045 E Front St Buchanan MI 49107-8474 Ph: (269) 695-5540 |
NPI Number | 1275687147 |
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Provider Enumeration Date | 01/22/2007 |
Last Update Date | 05/13/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275687147 | NPI | - | NPPES |
0877052 | Other | MI | BCBSM PROVIDER # |
0P302600003 | Other | MI | BCBSM |
0P30260006 | Other | MI | BCBSM |
5111155 | Other | MI | BCBSM PROVIDER # |
0A11219 | Other | MI | BCBSM PROVIDER # |
5113009 | Other | MI | BCBSM PROVIDER # |
2575222 | Medicaid | MI | |
5111148 | Other | MI | BCBSM PROVIDER NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 5101010822 (Michigan) | Primary |