Provider Demographics
NPI:1851490296
Name:WEST FRONT PRIMARY CARE, P.L.L.C.
Entity Type:Organization
Organization Name:WEST FRONT PRIMARY CARE, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:TOBIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-935-8930
Mailing Address - Street 1:4290 COPPER RIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7205
Mailing Address - Country:US
Mailing Address - Phone:231-935-8930
Mailing Address - Fax:231-935-8811
Practice Address - Street 1:4290 COPPER RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7205
Practice Address - Country:US
Practice Address - Phone:231-935-8930
Practice Address - Fax:231-935-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID #