| Organization Name: | NORTHRIDGE FAMILY PRACTICE LLC |
| NPI Number: | 1780803932 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBRA PROVOAST (OWNER) |
| Mailing Address: | 3190 Northridge Drive Hale |
| State: | MI US |
| Postal Code: | 487399276 |
| Phone Number: | 9897286000 |
| Fax Number: | 9897286003 |
| NPI Enumeration Date: | 04/25/2007 |
| NPI Last Update Date: | 01/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207R00000X |
| License Number: | 4301061417 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |