| Northern Phototherapy Management Facility Llc | |
|
337 E Houghton Ave Suite 3 West Branch MI 48661-1127 | |
| (989) 343-1000 | |
| (989) 345-5734 |
| Full Name | Northern Phototherapy Management Facility Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 337 E Houghton Ave, West Branch, Michigan |
| Authorized Official Name and Position | Joseph J Martines (OWNER) |
| Authorized Official Contact | 9893431000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Phototherapy Management Facility Llc 337 E Houghton Ave Suite 3 West Branch MI 48661-1127 Ph: (989) 343-1000 | Northern Phototherapy Management Facility Llc 337 E Houghton Ave Suite 3 West Branch MI 48661-1127 Ph: (989) 343-1000 |
| NPI Number | 1831251982 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4880644251 |
|---|---|
| Medicare Enrollment ID | O20050125000186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831251982 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Lori A Tetu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639710890 PECOS PAC ID: 3779910328 Enrollment ID: I20200221000064 |
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