Provider Demographics
NPI:1114157120
Name:CADILLAC OCCUPATIONAL MEDICINE
Entity Type:Organization
Organization Name:CADILLAC OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR BILLING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-9189
Mailing Address - Street 1:7985 MACKINAW TRL
Mailing Address - Street 2:STE B1
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8111
Mailing Address - Country:US
Mailing Address - Phone:231-779-5224
Mailing Address - Fax:231-779-5243
Practice Address - Street 1:7985 MACKINAW TRL
Practice Address - Street 2:STE B1
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8111
Practice Address - Country:US
Practice Address - Phone:231-779-5224
Practice Address - Fax:231-779-5243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine