Provider Demographics
NPI:1457540908
Name:RED ARROW FAMILY PRACTICE
Entity Type:Organization
Organization Name:RED ARROW FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-468-4100
Mailing Address - Street 1:6500 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-8700
Mailing Address - Country:US
Mailing Address - Phone:269-468-4100
Mailing Address - Fax:269-468-3334
Practice Address - Street 1:6500 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-8700
Practice Address - Country:US
Practice Address - Phone:269-468-4100
Practice Address - Fax:269-468-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI009859208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM93720Medicare PIN
E33129Medicare UPIN