Provider Demographics
NPI:1750744066
Name:INTEGRATIVE SPECIALTY CARE OF NORTHERN MICHIGAN
Entity type:Organization
Organization Name:INTEGRATIVE SPECIALTY CARE OF NORTHERN MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-348-3800
Mailing Address - Street 1:3250 WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-7628
Mailing Address - Country:US
Mailing Address - Phone:231-348-3800
Mailing Address - Fax:877-397-7480
Practice Address - Street 1:3250 WOODS WAY
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-7628
Practice Address - Country:US
Practice Address - Phone:231-348-3800
Practice Address - Fax:877-397-7480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010411052083P0901X, 207R00000X
MI43010412542083P0901X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty