Provider Demographics
NPI:1972605913
Name:MICHIGAN-WISCONSIN FAMILY PRACTICE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MICHIGAN-WISCONSIN FAMILY PRACTICE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-774-1633
Mailing Address - Street 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3650
Mailing Address - Country:US
Mailing Address - Phone:906-774-1633
Mailing Address - Fax:906-774-4451
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3650
Practice Address - Country:US
Practice Address - Phone:906-774-1633
Practice Address - Fax:906-774-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43055200Medicaid
WI43055200Medicaid
MI=========OtherTAX ID
MI233872Medicare ID - Type UnspecifiedRURAL HEALTH MEDICARE