Provider Demographics
NPI:1568768281
Name:MIDMICHIGAN URGNET CARE - FREELAND
Entity Type:Organization
Organization Name:MIDMICHIGAN URGNET CARE - FREELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-633-1350
Mailing Address - Street 1:2618 W SUGNET RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2647
Mailing Address - Country:US
Mailing Address - Phone:989-633-5237
Mailing Address - Fax:
Practice Address - Street 1:5694 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8845
Practice Address - Country:US
Practice Address - Phone:989-695-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDMICHIGAN URGENT CARE - MIDLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P35490Medicare PIN