Provider Demographics
NPI:1104353283
Name:WHOLE FAMILY DIRECT CARE
Entity type:Organization
Organization Name:WHOLE FAMILY DIRECT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MACHALKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-967-5155
Mailing Address - Street 1:1174 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1497
Mailing Address - Country:US
Mailing Address - Phone:269-558-0080
Mailing Address - Fax:269-781-2253
Practice Address - Street 1:1174 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1497
Practice Address - Country:US
Practice Address - Phone:269-558-0080
Practice Address - Fax:269-781-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083608208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty