Provider Demographics
NPI:1275583106
Name:NORTON REDI MED PLLC
Entity Type:Organization
Organization Name:NORTON REDI MED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:KIRCHHAINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:231-739-7334
Mailing Address - Street 1:747 W NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-6526
Mailing Address - Country:US
Mailing Address - Phone:231-739-7334
Mailing Address - Fax:231-737-6334
Practice Address - Street 1:747 W NORTON AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-6526
Practice Address - Country:US
Practice Address - Phone:231-739-7334
Practice Address - Fax:231-737-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWK049279208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4517658Medicaid
MIE30928Medicare UPIN
MI0N90270Medicare ID - Type Unspecified