Provider Demographics
NPI:1306881289
Name:MIDDLEVILLE DOCTORS, P.C.
Entity type:Organization
Organization Name:MIDDLEVILLE DOCTORS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINETTE
Authorized Official - Middle Name:I
Authorized Official - Last Name:GRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-795-3315
Mailing Address - Street 1:4695 N M 37 HWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-8276
Mailing Address - Country:US
Mailing Address - Phone:269-795-3315
Mailing Address - Fax:269-795-3542
Practice Address - Street 1:4695 N M 37 HWY
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8275
Practice Address - Country:US
Practice Address - Phone:269-795-3315
Practice Address - Fax:269-795-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION38850Medicare ID - Type Unspecified