MID-MICHIGAN DISTRICT HEALTH DEPARTMENT

Provider Demographics

• NPI: 1851386106
• Name: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT
• Entity Type: Organization
• Organization Name: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT
• Authorized Official - Title/Position: HEALTH OFFICER
• Authorized Official - Prefix: MRS
• Authorized Official - First Name: LIZ
• Authorized Official - Middle Name: MARI (JOHN)
• Authorized Official - Last Name: BRADDOCK
• Authorized Official - Credentials: RS MS
• Authorized Official - Phone: 989-831-3640
• Mailing Address - Street 1: 615 N STATE ST
• Mailing Address - Street 2: STE. 2
• Mailing Address - City: STANTON
• Mailing Address - State: MI
• Mailing Address - Zip Code: 48888-9702
• Mailing Address - Country: US
• Mailing Address - Phone: 989-831-5237
• Mailing Address - Fax: 989-831-5522
• Practice Address - Street 1: 615 N STATE ST
• Practice Address - Street 2: STE. 1
• Practice Address - City: STANTON
• Practice Address - State: MI
• Practice Address - Zip Code: 48888-9702
• Practice Address - Country: US
• Practice Address - Phone: 989-831-5237
• Practice Address - Fax: 989-831-3666
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-09-13
• Last Update Date: 2021-07-26

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2083P0901X	Allopathic & Osteopathic Physicians	Preventive Medicine	Public Health & General Preventive Medicine	Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	5100715	Medicaid
MI	1464384	Other	FACILITY/GROUP PROVIDER ID
MI	MI9754	Medicare PIN
MI	=========	Other	TAX ID
MI	X16976	Medicare UPIN
MI	0983712	Other	HEALTH PLUS
MI	5100724	Medicaid
MI	204173	Other	MC LAREN
MI	1845735	Medicaid
MI	2832310	Medicaid
MI	4098926	Medicaid
MI	5100715	Medicaid
MI	9370005	Other	PHP MSS ISS
MI	0E90450	Medicare ID - Type Unspecified	MEDICARE
MI	2832320	Medicaid
MI	350952	Other	COMMUNITY CARE
MI	600001336	Other	MEDICARE RAILROAD
MI	4154981	Medicaid
MI	5100733	Medicaid