Provider Demographics
NPI:1013022086
Name:CENTRAL MICHIGAN OSTEOPOROSIS TREATMENT CENTER, PLC
Entity Type:Organization
Organization Name:CENTRAL MICHIGAN OSTEOPOROSIS TREATMENT CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WULFEKUHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-227-1800
Mailing Address - Street 1:1015 S US HIGHWAY 27
Mailing Address - Street 2:SUITE B-37
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-2423
Mailing Address - Country:US
Mailing Address - Phone:989-227-1800
Mailing Address - Fax:989-227-1801
Practice Address - Street 1:1015 S US HIGHWAY 27
Practice Address - Street 2:SUITE B-37
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2423
Practice Address - Country:US
Practice Address - Phone:989-227-1800
Practice Address - Fax:989-227-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055180207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1101914331OtherBCBS OF MICHIGAN
MI1101914331OtherBCBS OF MICHIGAN