| Bayside Family & Sports Medicine Pc | |
|
2325 Summit Park Dr Suite 3 Petoskey MI 49770-8774 | |
| (231) 439-5100 | |
| (231) 439-9292 |
| Full Name | Bayside Family & Sports Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2325 Summit Park Dr, Petoskey, Michigan |
| Authorized Official Name and Position | Todd Edward Decker (OWNER/PRESIDENT) |
| Authorized Official Contact | 2314395100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bayside Family & Sports Medicine Pc 2325 Summit Park Dr Suite 3 Petoskey MI 49770-8774 Ph: (231) 439-5100 | Bayside Family & Sports Medicine Pc 2325 Summit Park Dr Suite 3 Petoskey MI 49770-8774 Ph: (231) 439-5100 |
| NPI Number | 1629251129 |
|---|---|
| Provider Enumeration Date | 12/07/2007 |
| Last Update Date | 04/10/2012 |
| Medicare PECOS PAC ID | 6608881867 |
|---|---|
| Medicare Enrollment ID | O20060209000544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629251129 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Todd M Sheperd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679597785 PECOS PAC ID: 5890689459 Enrollment ID: I20040212000879 |
| Provider Name | Lisa Marie Hoffman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164449765 PECOS PAC ID: 3173506607 Enrollment ID: I20040608000098 |
| Provider Name | Todd E Decker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871600676 PECOS PAC ID: 3779598933 Enrollment ID: I20060210000056 |
| Provider Name | Michelle Beigle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346625738 PECOS PAC ID: 9335457191 Enrollment ID: I20150929001461 |
| Provider Name | Margaret Emily-pawlowski Bovee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649815366 PECOS PAC ID: 1355721465 Enrollment ID: I20220707001542 |
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