Provider Demographics
NPI:1639351984
Name:ELK RAPIDS MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:ELK RAPIDS MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KUENKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-264-0700
Mailing Address - Street 1:516 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELK RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49629-9701
Mailing Address - Country:US
Mailing Address - Phone:231-264-0700
Mailing Address - Fax:
Practice Address - Street 1:516 BRIDGE ST
Practice Address - Street 2:POST OFFICE BOX 119
Practice Address - City:ELK RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49629-9701
Practice Address - Country:US
Practice Address - Phone:231-264-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAK1664069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0850500144OtherBCBS PROVIDER NUMBER
MI4165027Medicaid
MI4165027Medicaid
E25499Medicare UPIN