Provider Demographics
NPI:1104124171
Name:PARTNERS IN HEALTH OF TRAVERSE CITY
Entity type:Organization
Organization Name:PARTNERS IN HEALTH OF TRAVERSE CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:SPRINGSTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-929-1234
Mailing Address - Street 1:3074 N US 31 S
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4533
Mailing Address - Country:US
Mailing Address - Phone:231-935-0535
Mailing Address - Fax:231-935-0454
Practice Address - Street 1:3074 N US 31 S
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4533
Practice Address - Country:US
Practice Address - Phone:231-935-0535
Practice Address - Fax:231-935-0454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:URGENT CARE OF TRAVERSE CITY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-01
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1134124662OtherNPI DR NUSSDORFER
MI1073610945OtherNPI LORAH WRIGHT DO
MI1962408393OtherNPI DR VLACH
MI1265438790OtherNPI DR SPRINGSTEEN