| Gun Lake Tribe | |
|
2880 Mission Dr Shelbyville MI 49344-9580 | |
| (269) 397-1760 | |
| (269) 397-1763 |
| Full Name | Gun Lake Tribe |
|---|---|
| Speciality | Clinic/Center |
| Location | 2880 Mission Dr, Shelbyville, Michigan |
| Authorized Official Name and Position | Kelly Wesaw (HEALTH DIRECTOR) |
| Authorized Official Contact | 2693971760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gun Lake Tribe 2880 Mission Drive Shelbyville MI 49344 Ph: (269) 397-1760 | Gun Lake Tribe 2880 Mission Dr Shelbyville MI 49344-9580 Ph: (269) 397-1760 |
| NPI Number | 1952685588 |
|---|---|
| Provider Enumeration Date | 09/30/2011 |
| Last Update Date | 01/19/2022 |
| Medicare PECOS PAC ID | 9133350952 |
|---|---|
| Medicare Enrollment ID | O20140320000784 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952685588 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Daniel K Koschtial |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1467483727 PECOS PAC ID: 5193825917 Enrollment ID: I20180131001728 |
| Provider Name | Rebecca L Werner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629034244 PECOS PAC ID: 2466521430 Enrollment ID: I20190507000046 |
| Provider Name | Nicole Flory Sansom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295388098 PECOS PAC ID: 2062845456 Enrollment ID: I20200130001967 |
| Provider Name | Jolene Weesjes |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1548719354 PECOS PAC ID: 5496043762 Enrollment ID: I20221014002343 |
| Provider Name | Matthew Boyd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558580977 PECOS PAC ID: 0648371153 Enrollment ID: I20240422000132 |