Provider Demographics
NPI:1942402276
Name:DAVID E ATKINSON MD PC
Entity Type:Organization
Organization Name:DAVID E ATKINSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-563-9255
Mailing Address - Street 1:500 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49870-1238
Mailing Address - Country:US
Mailing Address - Phone:906-563-9255
Mailing Address - Fax:906-563-9706
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:MI
Practice Address - Zip Code:49870-1238
Practice Address - Country:US
Practice Address - Phone:906-563-9255
Practice Address - Fax:906-563-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042217207Q00000X
WI22074-020207Q00000X
SD2358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396726048OtherINDIVIDUAL NPI
WI30333800Medicaid
MI2107098Medicaid
MI9714600752OtherPREFERRED ONE
MI9714600752OtherPREFERRED ONE
WI30333800Medicaid