Provider Demographics
NPI:1578670113
Name:LITCHFIELD FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:LITCHFIELD FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-542-3217
Mailing Address - Street 1:413 N CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49252-9792
Mailing Address - Country:US
Mailing Address - Phone:517-542-3217
Mailing Address - Fax:517-542-3490
Practice Address - Street 1:413 N CHICAGO ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MI
Practice Address - Zip Code:49252-9792
Practice Address - Country:US
Practice Address - Phone:517-542-3217
Practice Address - Fax:517-542-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0853000095OtherBCBS
MI4125694Medicaid
MIG89914Medicare UPIN
MIOM83130Medicare ID - Type UnspecifiedMEDICARE ID