Organization
MID-MICHIGAN DISTRICT HEALTH DEPARTMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LIZ MARI (JOHN) BRADDOCK RS MS (HEALTH OFFICER)
(989) 831-3640
Entity
Organization
Contact information
Practice address
615 N STATE ST, STANTON, MI 48888-9702
(989) 831-5237
(989) 831-5522
Mailing address
615 N STATE ST, STE 2, STANTON, MI 48888-9702
(989) 831-5237
(989) 831-5522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4074187185
MI
207Q00000X
Family Medicine Physician
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2327700
—
MI
01
—
4301078076
PHYSICIAN LICENSE
MI
05
—
4632776
—
MI
01
—
4704187185
NURSE PRACTITIONER
MI
05
—
5100715
—
MI
Enumeration date
08/19/2015
Last updated
07/26/2021
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