Provider Demographics
NPI:1841286507
Name:SPAETH, DONALD GEORGE (DO, PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GEORGE
Last Name:SPAETH
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1185 US HIGHWAY 23 N
Mailing Address - Street 2:PO BOX 857
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-8018
Mailing Address - Country:US
Mailing Address - Phone:989-356-4049
Mailing Address - Fax:989-358-3712
Practice Address - Street 1:1185 US HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-8018
Practice Address - Country:US
Practice Address - Phone:989-356-4049
Practice Address - Fax:989-358-3712
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1841286507Medicaid
D89769Medicare UPIN
MI1841286507Medicaid