Provider Demographics
NPI:1447586540
Name:MICHIGAN MEDICAL PATIENT CARE
Entity Type:Organization
Organization Name:MICHIGAN MEDICAL PATIENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRING
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:616-974-4889
Mailing Address - Street 1:4085 BURTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2444
Mailing Address - Country:US
Mailing Address - Phone:616-974-4466
Mailing Address - Fax:
Practice Address - Street 1:6117 CHARLEVOIX WOODS CT SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8505
Practice Address - Country:US
Practice Address - Phone:616-954-2366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN MEDICAL PATIENT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-23
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty