| |
802 S Main St Ste 3 Cheboygan MI 49721-2269 | |
(231) 627-3002 | |
(231) 627-6204 |
Full Name | |
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Speciality | Family Medicine |
Location | 802 S Main St, Cheboygan, Michigan |
Authorized Official Name and Position | Roderick Jay Baltzer (PRESIDENT) |
Authorized Official Contact | 2316273002 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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802 S Main St Ste 3 Cheboygan MI 49721-2269 Ph: (231) 627-3002 | 802 S Main St Ste 3 Cheboygan MI 49721-2269 Ph: (231) 627-3002 |
NPI Number | 1356316186 |
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Provider Enumeration Date | 02/23/2006 |
Last Update Date | 10/02/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356316186 | NPI | - | NPPES |
1424279 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 5101006586 (Michigan) | Primary |
Leja Jackson Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 920 S Huron St, Cheboygan, MI 49721 Phone: 231-597-8192 Fax: 231-597-8463 | |