Organization
TRAVERSE CITY EYE CONSULTANTS P C
Active
Organization
TRAVERSE CITY EYE CONSULTANTS P C
Active
Parent organization
TRAVERSE CITY EYE CONSULTANTS P C
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRAVERSE CITY EYE CONSULTANTS P C
Authorized official
KENNETH B GUM M.D. (DOCTOR)
(231) 935-8101
Entity
Organization
Contact information
Practice address
419 S CORAL ST, KALKASKA, MI 49646-2500
(231) 935-8101
(231) 935-0955
Mailing address
5199 N ROYAL DR, TRAVERSE CITY, MI 49684-9201
(231) 935-8101
(231) 935-0955
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0N89560
—
MI
05
—
0N89570
—
MI
Enumeration date
12/15/2006
Last updated
03/30/2021
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