Provider Demographics
NPI:1659468064
Name:UPPER PENINSULA REHABILITATION MEDICINE ASSOCIATES P.C.
Entity Type:Organization
Organization Name:UPPER PENINSULA REHABILITATION MEDICINE ASSOCIATES P.C.
Other - Org Name:U P REHABILITATION MEDICINE ASSOCIATES PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-3914
Mailing Address - Street 1:580 WEST BARAGA AVENUE SUITE 30
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-3914
Mailing Address - Fax:906-225-4583
Practice Address - Street 1:580 WEST BARAGA AVENUE SUITE 30
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-3914
Practice Address - Fax:906-225-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI250E26047OtherBLUE CROSS BLUE SHIELD MI
MI250E26047OtherBLUE CROSS BLUE SHIELD MI
MI0E26047Medicare PIN