Provider Demographics
NPI:1023107604
Name:PARTRIDGE CREEK OBSTETRICS & GYNECOLOGY,P.C.
Entity type:Organization
Organization Name:PARTRIDGE CREEK OBSTETRICS & GYNECOLOGY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-247-8609
Mailing Address - Street 1:19991 HALL RD
Mailing Address - Street 2:STE 105
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4254
Mailing Address - Country:US
Mailing Address - Phone:586-247-8609
Mailing Address - Fax:586-247-8615
Practice Address - Street 1:19991 HALL RD
Practice Address - Street 2:STE 105
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044
Practice Address - Country:US
Practice Address - Phone:586-247-8609
Practice Address - Fax:586-247-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012054207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4195410Medicaid
MI4195400Medicaid
MIF58030Medicare UPIN
MI4195410Medicaid
MI0M97990Medicare ID - Type Unspecified