Organization
NORTHERN MICHIGAN MEDICAL MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE R. DEVET (C.E.O.)
(231) 487-4009
Entity
Organization
Contact information
Practice address
416 CONNABLE AVE, PETOSKEY, MI 49770-2212
(231) 487-4000
Mailing address
416 CONNABLE AVE, PETOSKEY, MI 49770-2212
(231) 487-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70-0-B411200
BCBSM
MI
01
—
900036710
PRIORITY HEALTH
MI
Enumeration date
03/14/2007
Last updated
10/05/2010
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