Organization
HACKLEY COMMUNITY CARE CENTER INC
Active
Other names
MIHP Hackley Community Care Center Inc
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE KOHN DO (CMP)
(231) 737-1335
Entity
Organization
Contact information
Practice address
2700 BAKER ST FL 3, MUSKEGON, MI 49444-2157
(231) 737-1335
(231) 737-0534
Mailing address
2700 BAKER ST FL 3, MUSKEGON, MI 49444-2157
(231) 737-1335
(231) 737-0534
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629066238
—
MI
Enumeration date
06/15/2016
Last updated
06/15/2016
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