Provider Demographics
NPI:1801364005
Name:NORTHERN FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:NORTHERN FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:TALMO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:231-347-1900
Mailing Address - Street 1:2810 CHARLEVOIX RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8421
Mailing Address - Country:US
Mailing Address - Phone:231-347-1900
Mailing Address - Fax:
Practice Address - Street 1:3890 CHARLEVOIX RD STE 230
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8420
Practice Address - Country:US
Practice Address - Phone:123-134-7190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301049260OtherSTATE LICENSE