Provider Demographics
NPI:1396889416
Name:EUCLID MEDICAL GROUP P.C.
Entity type:Organization
Organization Name:EUCLID MEDICAL GROUP P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-892-7722
Mailing Address - Street 1:1458 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-2112
Mailing Address - Country:US
Mailing Address - Phone:989-895-4860
Mailing Address - Fax:989-895-4870
Practice Address - Street 1:1458 W CENTER RD
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-2112
Practice Address - Country:US
Practice Address - Phone:989-895-4860
Practice Address - Fax:989-895-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MILS011227OtherBCBS
MI01006518OtherHEALTH PLUS
MI114982649Medicaid
MI1007493OtherMCLAREN
MI114982630Medicaid
MI115176034Medicaid
MI700Z910470OtherBCN
MIJG007063OtherBCBS
MIP43930004OtherMEDICARE GROUP
MI010Z911030OtherBCBS
MI114983950Medicaid
MIRK007099OtherBCBS
MILS011227OtherBCBS
MI700Z910470OtherBCN
MI115176034Medicaid
MI0P43930001Medicare PIN
MIP43930012Medicare PIN
MI114982630Medicaid
MIP43930011Medicare PIN
MI01006518OtherHEALTH PLUS