Organization
INTERNAL MEDICINE OF NORTHERN MICHIGAN LABORATORY
Active
Parent organization
INTERNAL MEDICINE OF NORTHERN MICHIGAN
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTERNAL MEDICINE OF NORTHERN MICHIGAN
Authorized official
MR. ROBERT FARRELL (PRACTICE ADMINISTRATOR)
(231) 487-9759
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
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B40023
BCBSM
MI
Enumeration date
06/28/2012
Last updated
06/28/2012
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