| Family And Lifestyle Medicine | |
|
12911 Kelly Ln Grand Ledge MI 48837-8926 | |
| (989) 493-9771 | |
| (517) 210-2202 |
| Full Name | Family And Lifestyle Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 12911 Kelly Ln, Grand Ledge, Michigan |
| Authorized Official Name and Position | Kimberly Azelton (MEDICAL DIRECTOR) |
| Authorized Official Contact | 5172580855 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family And Lifestyle Medicine 12911 Kelly Ln Grand Ledge MI 48837-8926 Ph: (989) 493-9771 | Family And Lifestyle Medicine 12911 Kelly Ln Grand Ledge MI 48837-8926 Ph: (989) 493-9771 |
| NPI Number | 1477291102 |
|---|---|
| Provider Enumeration Date | 05/23/2022 |
| Last Update Date | 05/23/2022 |
| Medicare PECOS PAC ID | 8123409018 |
|---|---|
| Medicare Enrollment ID | O20220725000634 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477291102 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jonathan Sharley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992325492 PECOS PAC ID: 0244654622 Enrollment ID: I20230720003238 |
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