Organization
SOMA MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE OETMAN (MEDICAL STAFF COORDINATOR)
(269) 639-2807
Entity
Organization
Contact information
Practice address
955 S BAILEY AVE, SOUTH HAVEN, MI 49090-6743
(269) 637-5271
(269) 639-2919
Mailing address
955 S BAILEY AVE, SOUTH HAVEN, MI 49090-6743
(269) 637-5271
(269) 639-2919
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
042007627
IL
282N00000X
General Acute Care Hospital
Primary
4301102383
MI
Other
Enumeration date
09/30/2006
Last updated
04/22/2013
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