Provider Demographics
NPI:1962438556
Name:KALKASKA FAMILY PRACTICE PC
Entity type:Organization
Organization Name:KALKASKA FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIRGY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-258-7570
Mailing Address - Street 1:419 S CORAL ST
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-2500
Mailing Address - Country:US
Mailing Address - Phone:231-258-7777
Mailing Address - Fax:
Practice Address - Street 1:419 S CORAL ST
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-2500
Practice Address - Country:US
Practice Address - Phone:231-258-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962438556Medicaid
MI080Z56005OtherBCBS
MI080Z56005OtherBCBS
MI233865Medicare Oscar/Certification