Provider Demographics
NPI:1952726606
Name:NORTHERN HEALTH & WELLNESS INC
Entity Type:Organization
Organization Name:NORTHERN HEALTH & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-356-3485
Mailing Address - Street 1:2079 SOUTH STATE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707
Mailing Address - Country:US
Mailing Address - Phone:989-354-2191
Mailing Address - Fax:989-356-0784
Practice Address - Street 1:2079 SOUTH STATE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707
Practice Address - Country:US
Practice Address - Phone:989-354-2191
Practice Address - Fax:989-356-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0040140OtherBCBSM PIN
MI4301093293OtherSTATE LICENSE NUMBER