Organization Name: | BAYSIDE DOC'S URGENT CARE OFFICE |
NPI Number: | 1134422777 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL J PARKER (OWNER) |
Mailing Address: | 401 Munson Ave Traverse City |
State: | MI US |
Postal Code: | 496863041 |
Phone Number: | 2319339150 |
Fax Number: | 2319331553 |
NPI Enumeration Date: | 12/20/2010 |
NPI Last Update Date: | 12/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 4301056827 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |