Provider Demographics
NPI:1679575971
Name:PULMONARY AND CRITICAL CARE OF NORTHWEST MICHIGAN, P.C.
Entity Type:Organization
Organization Name:PULMONARY AND CRITICAL CARE OF NORTHWEST MICHIGAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-0440
Mailing Address - Street 1:5087 N ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6987
Mailing Address - Country:US
Mailing Address - Phone:231-935-0440
Mailing Address - Fax:231-935-0445
Practice Address - Street 1:5087 N ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6987
Practice Address - Country:US
Practice Address - Phone:231-935-0440
Practice Address - Fax:231-935-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI431568207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI290B810080OtherBCBS
MI0M29650Medicare PIN
MI290B810080OtherBCBS