Provider Demographics
NPI:1396902904
Name:J. PHILLIP HORWICH M.D. PC
Entity type:Organization
Organization Name:J. PHILLIP HORWICH M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HORWICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-668-6282
Mailing Address - Street 1:52375 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:336 S KALAMAZOO MALL
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4859
Practice Address - Country:US
Practice Address - Phone:269-668-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071215207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4273641Medicaid
0N21600Medicare PIN
MI4273641Medicaid