Provider Demographics
NPI:1225185945
Name:DOUGLAS M PORTZ MD PC
Entity Type:Organization
Organization Name:DOUGLAS M PORTZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PORTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-475-3979
Mailing Address - Street 1:14650 OLD HIGHWAY US12
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118
Mailing Address - Country:US
Mailing Address - Phone:734-475-3979
Mailing Address - Fax:734-433-4513
Practice Address - Street 1:14650 OLD HIGHWAY US12
Practice Address - Street 2:SUITE 101
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-475-3979
Practice Address - Fax:734-433-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDP049712207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3085422Medicaid
MI3085422Medicaid
MID72606Medicare UPIN