Provider Demographics
NPI:1194501130
Name:CELLY HEALTH MEDICAL GROUP OF NORTHERN MICHIGAN PC
Entity type:Organization
Organization Name:CELLY HEALTH MEDICAL GROUP OF NORTHERN MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-235-5963
Mailing Address - Street 1:10850 E TRAVERSE HWY STE 1155
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-1363
Mailing Address - Country:US
Mailing Address - Phone:844-235-5963
Mailing Address - Fax:
Practice Address - Street 1:10850 E TRAVERSE HWY STE 1155
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-1363
Practice Address - Country:US
Practice Address - Phone:231-499-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty