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Organization
PROMEDICA CENTRAL CORPORATION OF MICHIGAN
Active
Organization
PROMEDICA CENTRAL CORPORATION OF MICHIGAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA WINES (DIRECTOR, SYSTEM CREDENTIALING)
(567) 585-0422
Entity
Organization
Contact information
Practice address
100 MADISON AVE, MSC-S38805, TOLEDO, OH 43604
(844) 373-0871
(419) 885-3921
Mailing address
100 MADISON AVE, MSC-S38805, TOLEDO, OH 43604
(844) 373-0871
(419) 885-3921
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
NULL
207L00000X
Anesthesiology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
MI
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
MI
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
MI
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
MI
207Y00000X
Otolaryngology Physician
—
MI
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
MI
261QR1300X
Rural Health Clinic/Center
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040D610940
BCBSMI
MI
01
—
080E810210
BCBSMI
MI
01
—
160D610660
BCBSMI
MI
05
—
2002924
—
OH
01
—
500E811000
BCBSMI
MI
01
—
CD9268
RRMC
MI
Enumeration date
03/23/2006
Last updated
10/04/2023
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