Provider Demographics
NPI:1306415286
Name:TRAVELING CARE PHYSICIANS PLLC
Entity Type:Organization
Organization Name:TRAVELING CARE PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOHNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-642-9893
Mailing Address - Street 1:9471 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9480
Mailing Address - Country:US
Mailing Address - Phone:248-642-9893
Mailing Address - Fax:
Practice Address - Street 1:9471 RIDGE RD
Practice Address - Street 2:
Practice Address - City:GOODRICH
Practice Address - State:MI
Practice Address - Zip Code:48438-9480
Practice Address - Country:US
Practice Address - Phone:248-642-9893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty