Organization
JOHN STREET CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOTERO M URETA M.D. (OWNER)
(231) 839-4359
Entity
Organization
Contact information
Practice address
112 E JOHN ST, LAKE CITY, MI 49651
(231) 839-4359
(231) 839-0223
Mailing address
PO BOX 213, CADILLAC, MI 49601-0213
(231) 775-6076
(231) 775-0027
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
02/20/2007
Last updated
08/05/2010
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