| Primary Care Sports Medicine Pc | |
|
560 W Mitchell St Suite 340 Petoskey MI 49770-2275 | |
| (231) 348-9710 | |
| (231) 348-9715 |
| Full Name | Primary Care Sports Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 560 W Mitchell St, Petoskey, Michigan |
| Authorized Official Name and Position | Todd M Sheperd (PRESIDENT) |
| Authorized Official Contact | 2313489710 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Sports Medicine Pc 560 W Mitchell St Suite 340 Petoskey MI 49770-2275 Ph: (231) 348-9710 | Primary Care Sports Medicine Pc 560 W Mitchell St Suite 340 Petoskey MI 49770-2275 Ph: (231) 348-9710 |
| NPI Number | 1972658136 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 07/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972658136 | NPI | - | NPPES |
| 104701069 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4301074786 (Michigan) | Primary |
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