| Im | |
|
740 S Main St Cheboygan MI 49721-2220 | |
| (231) 627-9921 | |
| (231) 627-1312 |
| Full Name | Im |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 740 S Main St, Cheboygan, Michigan |
| Authorized Official Name and Position | Holly Campa (VICE PRESIDENT/FINANCE) |
| Authorized Official Contact | 2316271203 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Im Po Box 419 Cheboygan MI 49721-0419 Ph: (231) 627-1438 | Im 740 S Main St Cheboygan MI 49721-2220 Ph: (231) 627-9921 |
| NPI Number | 1316968043 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 12/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316968043 | NPI | - | NPPES |
| 110A610070 | Other | MI | GROUP BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (Michigan) | Primary |
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