Provider Demographics
NPI:1760660401
Name:MSN HEALTHCARE
Entity Type:Organization
Organization Name:MSN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-847-4700
Mailing Address - Street 1:1715 W DEAN RD STE B
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9406
Mailing Address - Country:US
Mailing Address - Phone:734-847-4700
Mailing Address - Fax:734-847-4711
Practice Address - Street 1:1715 W DEAN RD STE B
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-9406
Practice Address - Country:US
Practice Address - Phone:734-847-4700
Practice Address - Fax:734-847-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013724261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0155810705OtherBLUE CROSS BLUE SHIELD