Provider Demographics
NPI:1285863571
Name:GARLICK, COURTNEY (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GARLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-0208
Mailing Address - Country:US
Mailing Address - Phone:231-722-6005
Mailing Address - Fax:231-726-2804
Practice Address - Street 1:605 W WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1080
Practice Address - Country:US
Practice Address - Phone:231-722-6005
Practice Address - Fax:231-726-2804
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010948652085R0202X
OH35.1234152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285863571Medicaid
OH0103412Medicaid
OHH313540Medicare PIN