Provider Demographics
NPI:1689711772
Name:MYMICHIGAN MEDICAL CENTER ALPENA
Entity Type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER ALPENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:KALE
Authorized Official - Last Name:LEPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:989-734-4254
Mailing Address - Street 1:4000 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-0001
Mailing Address - Country:US
Mailing Address - Phone:989-734-4254
Mailing Address - Fax:
Practice Address - Street 1:2402 BRADLEY HIGHWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779
Practice Address - Country:US
Practice Address - Phone:989-734-4254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYMICHIGAN HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-30
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002011282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital