Provider Demographics
NPI:1841223948
Name:PHYSICIAN PRACTICE NETWORK
Entity Type:Organization
Organization Name:PHYSICIAN PRACTICE NETWORK
Other - Org Name:CADILLAC HOSPITALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZDRODOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-876-6730
Mailing Address - Street 1:400 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2331
Mailing Address - Country:US
Mailing Address - Phone:231-876-7200
Mailing Address - Fax:231-876-6519
Practice Address - Street 1:400 HOBART ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2331
Practice Address - Country:US
Practice Address - Phone:231-876-7200
Practice Address - Fax:231-876-6519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H310180OtherBLUE CROSS BLUE SHIELD
MICH3853Medicare PIN
MI110H310180OtherBLUE CROSS BLUE SHIELD