Organization
HPCN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA ELLISON (ACCOUNTING MANAGER)
(231) 728-1676
Entity
Organization
Contact information
Practice address
1675 LEAHY ST, SUITE 315A, MUSKEGON, MI 49442-5500
(231) 728-1680
(231) 728-1685
Mailing address
1675 LEAHY ST, SUITE 315A, MUSKEGON, MI 49442-5500
(231) 728-1680
(231) 728-1685
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/13/2006
Last updated
04/20/2008
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