# JOHN STREET CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033253133
- **Authorized official:** SOTERO M URETA M.D. (OWNER)
- **Authorized official phone:** (231) 839-4359

## Contact information

- **Practice address:** 112 E JOHN ST, LAKE CITY, MI 49651
- **Practice address phone:** (231) 839-4359
- **Practice address fax:** (231) 839-0223
- **Mailing address:** PO BOX 213, CADILLAC, MI 49601-0213
- **Mailing address phone:** (231) 775-6076
- **Mailing address fax:** (231) 775-0027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 02/20/2007
- **Last updated:** 08/05/2010