# NORTHSHORE MEDICAL CLINIC P C

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

## Provider details

- **NPI number:** 1841357464
- **Authorized official:** DR. JEROME E SIUDARA D.O. (PHYSICIAN)
- **Authorized official phone:** (231) 627-2869

## Contact information

- **Practice address:** 7786 MULLETT LAKE RD, CHEBOYGAN, MI 49721-9056
- **Practice address phone:** (231) 627-2869
- **Practice address fax:** (231) 627-2869
- **Mailing address:** 7786 MULLETT LAKE RD, CHEBOYGAN, MI 49721-9056
- **Mailing address phone:** (231) 627-2869
- **Mailing address fax:** (231) 627-2869

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 5101005875 | MI | Yes |

## Other

- **Enumeration date:** 01/02/2007
- **Last updated:** 12/19/2008