Provider Demographics
NPI:1689716557
Name:CLINICAL PRACTICE MANAGERS AND CONSULTANTS OF NORTHWEST MICHIGAN PLLC
Entity Type:Organization
Organization Name:CLINICAL PRACTICE MANAGERS AND CONSULTANTS OF NORTHWEST MICHIGAN PLLC
Other - Org Name:THE RENAISSANCE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOTERO
Authorized Official - Middle Name:
Authorized Official - Last Name:URETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-839-4359
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0213
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:112 JOHN STREET
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49601
Practice Address - Country:US
Practice Address - Phone:231-839-4359
Practice Address - Fax:231-839-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty