Provider Demographics
NPI:1104988252
Name:MT. PLEASANT MEDICAL PRACTICE, P.C.
Entity type:Organization
Organization Name:MT. PLEASANT MEDICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIS
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:ATCHOO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-953-5400
Mailing Address - Street 1:314 S BROWN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2936
Mailing Address - Country:US
Mailing Address - Phone:989-953-5400
Mailing Address - Fax:989-953-5401
Practice Address - Street 1:314 S BROWN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2936
Practice Address - Country:US
Practice Address - Phone:989-953-5400
Practice Address - Fax:989-953-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFA011418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG15178Medicare UPIN
MIN41590001Medicare ID - Type Unspecified
MIN41590002Medicare ID - Type Unspecified
MIB47935Medicare UPIN
MI0N44960Medicare ID - Type UnspecifiedRON MINGLE PAC