Organization
GRAND TRAVERSE PHYSICIAN SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH HEINRICH MD (OWNER/PRESIDENT)
(337) 609-1221
Entity
Organization
Contact information
Practice address
1105 6TH ST, TRAVERSE CITY, MI 49684-2386
(231) 935-5000
(231) 935-6548
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
02/05/2025
Last updated
03/19/2025
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