| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 720 4th St, Lapeer, Michigan |
| Authorized Official Name and Position | Russell L Bush (PRESIDENT) |
| Authorized Official Contact | 8102085222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
720 4th St Lapeer MI 48446-1447 Ph: (810) 664-8523 | 720 4th St Lapeer MI 48446-1447 Ph: (810) 664-8523 |
| NPI Number | 1568699239 |
|---|---|
| Provider Enumeration Date | 06/19/2009 |
| Last Update Date | 06/19/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568699239 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4301405603 (Michigan) | Primary |
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