Organization
MCLAREN PORT HURON
Active
Organization
MCLAREN PORT HURON
Active
Other names
PORT HURON HOSPITAL PHYSICIAN GRP
Organization subpart
No
Provider details
NPI number
Authorized official
BRIDGET SHOLTIS (VP/CFO)
(810) 989-3749
Entity
Organization
Contact information
Practice address
1209 RICHARDSON ST, PORT HURON, MI 48060-3548
(810) 984-5156
Mailing address
1221 PINE GROVE AVE, PORT HURON, MI 48060-3511
(810) 984-5156
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
MN084311
MI
1041C0700X
Clinical Social Worker
AG643729
MI
207R00000X
Internal Medicine Physician
MS040821
MI
2084P0800X
Psychiatry Physician
Primary
JM013191
MI
Other
Enumeration date
04/24/2009
Last updated
07/30/2020
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