Provider Demographics
NPI:1558308031
Name:RUMMERY, HAROLD ARTHUR (DO)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:ARTHUR
Last Name:RUMMERY
Suffix:
Gender:M
Credentials:DO
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 673397
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3397
Mailing Address - Country:US
Mailing Address - Phone:886-898-7139
Mailing Address - Fax:616-975-9824
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49443
Practice Address - Country:US
Practice Address - Phone:231-739-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012678207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114735183Medicaid
MIHR012678OtherBCBS
MI114107758Medicaid
P17640005Medicare PIN
MIE96010077Medicare PIN
930074120Medicare PIN
G06043012Medicare PIN
MI114735183Medicaid