Provider Demographics
NPI:1932333135
Name:NORTHERN MICHIGAN RHEUMATOLOGY PC
Entity Type:Organization
Organization Name:NORTHERN MICHIGAN RHEUMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAZMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-995-4902
Mailing Address - Street 1:3280 WOODS WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8105
Mailing Address - Country:US
Mailing Address - Phone:231-995-4902
Mailing Address - Fax:231-995-9074
Practice Address - Street 1:3280 WOODS WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8105
Practice Address - Country:US
Practice Address - Phone:231-995-4902
Practice Address - Fax:231-995-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041105261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA14964Medicare UPIN