Provider Demographics
NPI:1528168895
Name:NORTHERN MICHIGAN MEDICINE AND PEDIATRICS, PLLC
Entity type:Organization
Organization Name:NORTHERN MICHIGAN MEDICINE AND PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:KUHN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-935-0614
Mailing Address - Street 1:3643 W FRONT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7759
Mailing Address - Country:US
Mailing Address - Phone:231-935-0614
Mailing Address - Fax:231-935-0832
Practice Address - Street 1:3643 W FRONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7759
Practice Address - Country:US
Practice Address - Phone:231-935-0614
Practice Address - Fax:231-935-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII33597Medicare UPIN
MIF36490Medicare UPIN
MIN97750001Medicare ID - Type Unspecified
MIB54996Medicare UPIN
MIF31043Medicare UPIN
MIG48374Medicare UPIN
MIN97750002Medicare ID - Type Unspecified
MION97750Medicare ID - Type Unspecified
MIN97750005Medicare ID - Type Unspecified