Organization
COUNTY OF LAPEER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTIN FANTIN (OUTPT CLINIC/REIMBURSEMENT MANAGER)
(810) 667-0500
Entity
Organization
Contact information
Practice address
1570 SUNCREST DR, LAPEER, MI 48446-1154
(810) 667-0500
Mailing address
1570 SUNCREST DR, LAPEER, MI 48446-1154
(810) 667-0500
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1705242
—
MI
01
—
750910711
BCBS
MI
Enumeration date
05/17/2006
Last updated
08/28/2015
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