Provider Demographics
NPI:1053819623
Name:NORTHERN MICHIGAN HEART CENTER, PLLC
Entity Type:Organization
Organization Name:NORTHERN MICHIGAN HEART CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MULHOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-340-2550
Mailing Address - Street 1:2079 US HIGHWAY 23 S
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4524
Mailing Address - Country:US
Mailing Address - Phone:989-340-2550
Mailing Address - Fax:989-340-2551
Practice Address - Street 1:2079 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4524
Practice Address - Country:US
Practice Address - Phone:989-340-2550
Practice Address - Fax:989-340-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086730207RC0000X
208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty