Provider Demographics
NPI:1619946373
Name:FAMILY MEDICINE ASSOCIATES OF MIDLAND, P.C.
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF MIDLAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDERGERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-631-9515
Mailing Address - Street 1:885 E RAILWAY ST
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48618-9580
Mailing Address - Country:US
Mailing Address - Phone:989-465-6163
Mailing Address - Fax:989-465-1121
Practice Address - Street 1:885 E RAILWAY ST
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:MI
Practice Address - Zip Code:48618-9580
Practice Address - Country:US
Practice Address - Phone:989-465-6163
Practice Address - Fax:989-465-1121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY MEDICINE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-15
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E66006Medicare ID - Type Unspecified