Provider Demographics
NPI:1639215429
Name:NORTH, MICHAEL D (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:NORTH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13468 COTTAGE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:GOWEN
Mailing Address - State:MI
Mailing Address - Zip Code:49326-9496
Mailing Address - Country:US
Mailing Address - Phone:616-200-5131
Mailing Address - Fax:
Practice Address - Street 1:1982 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 815
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1736
Practice Address - Country:US
Practice Address - Phone:517-349-0784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34040083Medicare PIN
MIT33226Medicare UPIN