Organization
TRAVERSE OBSERVATION PHYSICIAN SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. YVONNE EVELYNE KAEHLER (BUSINESS MANAGER)
(231) 947-0673
Entity
Organization
Contact information
Practice address
1105 6TH ST, TRAVERSE CITY, MI 49684-2345
(231) 947-0673
Mailing address
4624 N SPIDER LAKE RD, TRAVERSE CITY, MI 49696-8440
(231) 947-0673
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001
PRIORITY HEALTH
MI
Enumeration date
08/25/2011
Last updated
11/02/2011
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