Provider Demographics
NPI:1457587016
Name:PHYSICIAN HEALTHCARE NETWORK-EMERGENCY MEDICINE
Entity Type:Organization
Organization Name:PHYSICIAN HEALTHCARE NETWORK-EMERGENCY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-385-8082
Mailing Address - Street 1:3050 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3819
Mailing Address - Country:US
Mailing Address - Phone:810-385-5099
Mailing Address - Fax:810-385-4933
Practice Address - Street 1:1221 PINE GROVE AVE
Practice Address - Street 2:EMERGENCY MEDICINE
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3511
Practice Address - Country:US
Practice Address - Phone:810-385-5099
Practice Address - Fax:810-385-4933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN HEALTHCARE NETWORK, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty