Provider Demographics
NPI:1982609202
Name:TRACY, NORINE (MD)
Entity Type:Individual
Prefix:DR
First Name:NORINE
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:202 E VAN RIPER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-7947
Mailing Address - Country:US
Mailing Address - Phone:517-223-7900
Mailing Address - Fax:517-223-7635
Practice Address - Street 1:202 E VAN RIPER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-7947
Practice Address - Country:US
Practice Address - Phone:517-223-7900
Practice Address - Fax:517-223-7635
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301060017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI04498516Medicaid
MI0P09430Medicare PIN
MI04498516Medicaid