Provider Demographics
NPI:1629094818
Name:PETOSKEY URGENT CARE PC
Entity Type:Organization
Organization Name:PETOSKEY URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:BANYAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-2000
Mailing Address - Street 1:1890 S US HIGHWAY 131
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8344
Mailing Address - Country:US
Mailing Address - Phone:231-487-2000
Mailing Address - Fax:
Practice Address - Street 1:1890 S US HIGHWAY 131
Practice Address - Street 2:SUITE 4
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8344
Practice Address - Country:US
Practice Address - Phone:231-487-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700B41015OtherBCBS
MI700B41015OtherBCBS
MI700B41015OtherBCBS