Provider Demographics
NPI:1730145574
Name:PETOSKEY SURGEONS, P.C.
Entity Type:Organization
Organization Name:PETOSKEY SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-1900
Mailing Address - Street 1:521 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2266
Mailing Address - Country:US
Mailing Address - Phone:231-487-1900
Mailing Address - Fax:231-348-0984
Practice Address - Street 1:521 MONROE ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2266
Practice Address - Country:US
Practice Address - Phone:231-487-1900
Practice Address - Fax:231-348-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020B41012OtherBLUE CARE NETWORK
MI020B41012OtherBLUE CROSS BLUE SHIELD
MI=========OtherPRIORITY HEALTH
0M75210Medicare UPIN