Provider Demographics
NPI:1285819995
Name:RENAISSANCE WOMEN'S HEALTH, PLC
Entity Type:Organization
Organization Name:RENAISSANCE WOMEN'S HEALTH, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-398-0222
Mailing Address - Street 1:1293 E PARKDALE AVE
Mailing Address - Street 2:SUITE 1200A
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-8904
Mailing Address - Country:US
Mailing Address - Phone:231-398-0222
Mailing Address - Fax:231-398-0225
Practice Address - Street 1:1293 E PARKDALE AVE
Practice Address - Street 2:SUITE 1200A
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-8904
Practice Address - Country:US
Practice Address - Phone:231-398-0222
Practice Address - Fax:231-398-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012161207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4074432Medicaid
MI0M77570Medicare PIN
MI4074432Medicaid