# PORT HURON PHYSICIANS MEDICAL GROUP PC

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

## Provider details

- **NPI number:** 1902281736
- **Authorized official:** REBEKAH SMITH (CEO)
- **Authorized official phone:** (810) 985-1510

## Contact information

- **Practice address:** 4190 24TH AVE, STE 206, FORT GRATIOT, MI 48059-3882
- **Practice address phone:** (810) 989-7700
- **Mailing address:** 4190 24TH AVE, STE 206, FORT GRATIOT, MI 48059-3882
- **Mailing address phone:** (810) 989-7700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/22/2015
- **Last updated:** 07/22/2015