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59057 Gratiot Ave New Haven MI 48048-2057 | |
(810) 404-2521 | |
(888) 414-4545 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 59057 Gratiot Ave, New Haven, Michigan |
Authorized Official Name and Position | Marcus Kyle Free (OWNER/PRESIDENT) |
Authorized Official Contact | 8104042521 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2143 Derfla Dr Saint Joseph MI 49085-9661 Ph: (810) 404-2521 | 59057 Gratiot Ave New Haven MI 48048-2057 Ph: (810) 404-2521 |
NPI Number | 1679091540 |
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Provider Enumeration Date | 08/31/2017 |
Last Update Date | 06/16/2018 |
Identifier | Type | State | Issuer |
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1679091540 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | 4301093347 (Michigan) | Primary |