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Organization
NORTHSHORE MEDICAL CLINIC P C
Active
Organization
NORTHSHORE MEDICAL CLINIC P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME E SIUDARA D.O. (PHYSICIAN)
(231) 627-2869
Entity
Organization
Contact information
Practice address
7786 MULLETT LAKE RD, CHEBOYGAN, MI 49721-9056
(231) 627-2869
(231) 627-2869
Mailing address
7786 MULLETT LAKE RD, CHEBOYGAN, MI 49721-9056
(231) 627-2869
(231) 627-2869
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5101005875
MI
Other
Enumeration date
01/02/2007
Last updated
12/19/2008
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