Provider Demographics
NPI:1396958500
Name:NORTHERN MICHIGAN ALLERGY & ASTHMA CENTER, P.C.
Entity type:Organization
Organization Name:NORTHERN MICHIGAN ALLERGY & ASTHMA CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LINEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-487-6575
Mailing Address - Street 1:405 N DIVISION RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9045
Mailing Address - Country:US
Mailing Address - Phone:231-487-6575
Mailing Address - Fax:231-439-9837
Practice Address - Street 1:405 N DIVISION RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9045
Practice Address - Country:US
Practice Address - Phone:231-487-6575
Practice Address - Fax:231-439-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL052216207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4091246-10Medicaid
MI0302464921OtherBLUE CROSS PIN
MI030004444OtherRAILROAD MEDICARE
MI030004444OtherRAILROAD MEDICARE
MIF04759Medicare UPIN