Provider Demographics
NPI:1528207560
Name:NORTHERN LIGHTS FAMILY MEDICINE P. C.
Entity Type:Organization
Organization Name:NORTHERN LIGHTS FAMILY MEDICINE P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-557-5367
Mailing Address - Street 1:9883 US 31
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MI
Mailing Address - Zip Code:49437-9501
Mailing Address - Country:US
Mailing Address - Phone:231-893-6363
Mailing Address - Fax:
Practice Address - Street 1:9883 US 31
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-9501
Practice Address - Country:US
Practice Address - Phone:231-893-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049583261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1649257445OtherNPI-INDIVIDUAL
MI4287709Medicaid