Provider Demographics
NPI:1619029923
Name:HAND SURGERY OF NORTHERN MICHIGAN PLC
Entity Type:Organization
Organization Name:HAND SURGERY OF NORTHERN MICHIGAN PLC
Other - Org Name:TRAVERSE BAY HAND THERAPY PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-995-9748
Mailing Address - Street 1:701 W FRONT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2236
Mailing Address - Country:US
Mailing Address - Phone:231-995-9758
Mailing Address - Fax:231-995-9745
Practice Address - Street 1:701 W FRONT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2236
Practice Address - Country:US
Practice Address - Phone:231-995-9758
Practice Address - Fax:231-995-9745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B81023OtherBCBSM
MI0N13430Medicare PIN
5654790001Medicare NSC