Provemont Family Care, Plc | |
49 N Eagle Hwy Lake Leelanau MI 49653-9778 | |
(231) 256-0606 | |
(231) 256-0671 |
Full Name | Provemont Family Care, Plc |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 49 N Eagle Hwy, Lake Leelanau, Michigan |
Authorized Official Name and Position | Dona D. Alba (PRESIDENT) |
Authorized Official Contact | 2312560606 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Provemont Family Care, Plc Po Box 180 Lake Leelanau MI 49653-0180 Ph: (231) 256-0606 | Provemont Family Care, Plc 49 N Eagle Hwy Lake Leelanau MI 49653-9778 Ph: (231) 256-0606 |
NPI Number | 1013109214 |
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Provider Enumeration Date | 08/13/2007 |
Last Update Date | 08/13/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013109214 | NPI | - | NPPES |
4849101 | Medicaid | MI | |
1164458295 | Other | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 5101016681 (Michigan) | Primary |