Provider Demographics
NPI:1720782030
Name:CATER, SIDNEY
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:CATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 E ARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:ROTHBURY
Mailing Address - State:MI
Mailing Address - Zip Code:49452-8150
Mailing Address - Country:US
Mailing Address - Phone:231-720-5566
Mailing Address - Fax:
Practice Address - Street 1:1115 BALL AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5904
Practice Address - Country:US
Practice Address - Phone:616-456-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC360766210283347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle