Organization
SIC OF MICHIGAN, PC
Active
Organization
SIC OF MICHIGAN, PC
Active
Other names
Centers at SIC
Organization subpart
No
Provider details
NPI number
Authorized official
JOSH VANDER LUGT (OWNER)
(616) 366-5079
Entity
Organization
Contact information
Practice address
4290 COPPER RIDGE DR STE 130, TRAVERSE CITY, MI 49684-7205
(231) 252-0893
Mailing address
4290 COPPER RIDGE DR STE 130, TRAVERSE CITY, MI 49684-7205
(231) 252-0893
Taxonomy
Speciality
Code
Description
License number
State
209800000X
Legal Medicine (M.D./D.O.) Physician
Primary
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
Other
Enumeration date
04/09/2025
Last updated
03/20/2026
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