Organization
MANISTEE ORTHOPAEDICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMMY BAUMAN (BILLER)
(231) 398-1752
Entity
Organization
Contact information
Practice address
1293 E PARKDALE AVE, SUITE 2200, MANISTEE, MI 49660-8904
(231) 398-1750
(231) 398-1751
Mailing address
1293 E PARKDALE AVE, SUITE 2200, MANISTEE, MI 49660-8904
(231) 398-1750
(231) 398-1751
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301046367
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005155171
BCBS
MI
05
—
4743229
—
MI
Enumeration date
11/01/2006
Last updated
08/22/2020
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