| Organization Name: | AMERICAN WELL PHYSICIANS MICHIGAN PC |
| NPI Number: | 1457787160 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PETER ANTALL (PRESIDENT) |
| Mailing Address: | 75 State St Fl 26 Boston |
| State: | MA US |
| Postal Code: | 021091827 |
| Phone Number: | 6172043500 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2013 |
| NPI Last Update Date: | 01/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |