| |
200 North Maple Street Fennville MI 49408-0664 | |
(269) 561-8761 | |
(269) 561-6040 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 200 North Maple Street, Fennville, Michigan |
Authorized Official Name and Position | Kenneth Earl Kratzer (PRESIDENT) |
Authorized Official Contact | 2695618761 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 664 Fennville MI 49408-0664 Ph: (269) 561-8761 | 200 North Maple Street Fennville MI 49408-0664 Ph: (269) 561-8761 |
NPI Number | 1174705933 |
---|---|
Provider Enumeration Date | 12/03/2007 |
Last Update Date | 05/22/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174705933 | NPI | - | NPPES |
111035922 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |