Organization
INTERNAL MEDICINE OF NORTHERN MICHIGAN PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT E FARRELL (PRACTICE ADMINISTRATOR)
(231) 487-2460
Entity
Organization
Contact information
Practice address
560 W MITCHELL ST, SUITE 300, PETOSKEY, MI 49770-2275
(231) 487-2460
(231) 487-6596
Mailing address
560 W MITCHELL ST, SUITE 300, PETOSKEY, MI 49770-2275
(231) 487-2460
(231) 487-6596
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110B410170
MICHIGAN BCBS
—
01
—
20146
PRIORITY HEALTH GROUP ID
—
01
—
619706
ANTHEM BCBS
—
01
—
99111316
HIRSP
—
01
—
CF8034
RR MEDICARE
—
Enumeration date
03/10/2006
Last updated
08/17/2011
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