| Organization Name: | UPPER GREAT LAKES FAMILY HEALTH CENTER |
| NPI Number: | 1114354479 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DONALD A SIMILA (CEO) |
| Mailing Address: | 56901 S 6th St Suite 1 & 2 Calumet |
| State: | MI US |
| Postal Code: | 499132946 |
| Phone Number: | 9064831177 |
| Fax Number: | 9064831188 |
| NPI Enumeration Date: | 10/02/2013 |
| NPI Last Update Date: | 04/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |