Provider Demographics
NPI:1104441302
Name:MI PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:MI PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:989-303-4101
Mailing Address - Street 1:4950 E BLUE GRASS RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-6020
Mailing Address - Country:US
Mailing Address - Phone:989-817-4640
Mailing Address - Fax:833-974-2264
Practice Address - Street 1:4950 E BLUE GRASS RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-6020
Practice Address - Country:US
Practice Address - Phone:989-817-4640
Practice Address - Fax:833-974-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care