Provider Demographics
NPI:1134176761
Name:NORTHERN MICHIGAN EMERGENCY PHYSICIANS, P.C
Entity type:Organization
Organization Name:NORTHERN MICHIGAN EMERGENCY PHYSICIANS, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP HEAD
Authorized Official - Prefix:MR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ATTIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-4000
Mailing Address - Street 1:405 N DIVISION RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9046
Mailing Address - Country:US
Mailing Address - Phone:231-348-7900
Mailing Address - Fax:
Practice Address - Street 1:416 CONNABLE AVE
Practice Address - Street 2:ER DEPARTMENT
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2212
Practice Address - Country:US
Practice Address - Phone:231-487-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI5296OtherRR MEDICARE
MI010A510070OtherBCBS
MI010A510070OtherBCBS