| Organization Name: | PORTAGE PHYSICIAN PRACTICES INC |
| NPI Number: | 1225461684 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JESS N JUDY (PRESIDENT) |
| Mailing Address: | 500 Campus Dr Ste. 5 Hancock |
| State: | MI US |
| Postal Code: | 499301569 |
| Phone Number: | 9064831700 |
| Fax Number: | 9064831270 |
| NPI Enumeration Date: | 08/20/2013 |
| NPI Last Update Date: | 08/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |