Organization
WEST BRANCH NERUOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONI LEWIS (OFFICE MANAGER)
(989) 345-4343
Entity
Organization
Contact information
Practice address
335 E HOUGHTON AVE, WEST BRANCH, MI 48661-1127
(989) 345-4343
(989) 345-4344
Mailing address
335 E HOUGHTON AVE, WEST BRANCH, MI 48661-1127
(989) 345-4343
(989) 345-4344
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
DP009646
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1012243
HEALTH ADVANTAGE
—
01
—
1356510065
BLUE CROSS BLUE SHIELD
MI
01
—
OP03260001
MEDICARE PLUS BLUE
MI
01
—
P00203101
MEDICARE RAILROAD
—
Enumeration date
09/27/2007
Last updated
09/27/2007
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