Organization
PORT HURON PHYSICIANS MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBEKAH SMITH (CEO)
(810) 985-1510
Entity
Organization
Contact information
Practice address
4190 24TH AVE, STE 206, FORT GRATIOT, MI 48059-3882
(810) 989-7700
Mailing address
4190 24TH AVE, STE 206, FORT GRATIOT, MI 48059-3882
(810) 989-7700
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
07/22/2015
Last updated
07/22/2015
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