Provider Demographics
NPI:1932249984
Name:CEDAR HILL MEDICAL PC
Entity Type:Organization
Organization Name:CEDAR HILL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-466-2000
Mailing Address - Street 1:2845 US HIGHWAY 2/41
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BARK RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49807-9661
Mailing Address - Country:US
Mailing Address - Phone:906-466-2000
Mailing Address - Fax:906-466-2027
Practice Address - Street 1:2845 US HIGHWAY 2/41
Practice Address - Street 2:SUITE 201
Practice Address - City:BARK RIVER
Practice Address - State:MI
Practice Address - Zip Code:49807-9661
Practice Address - Country:US
Practice Address - Phone:906-466-2000
Practice Address - Fax:906-466-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076738207Q00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH65308Medicare UPIN
MIH99419Medicare UPIN
MIF95738Medicare UPIN
P42470004Medicare PIN