| Provemont Family Care, Plc | |
|
49 N Eagle Hwy Lake Leelanau MI 49653-9778 | |
| (231) 256-0606 | |
| (231) 256-0671 |
| Full Name | Provemont Family Care, Plc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 49 N Eagle Hwy, Lake Leelanau, Michigan |
| Authorized Official Name and Position | Dona D. Alba (PRESIDENT) |
| Authorized Official Contact | 2312560606 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provemont Family Care, Plc Po Box 180 Lake Leelanau MI 49653-0180 Ph: (231) 256-0606 | Provemont Family Care, Plc 49 N Eagle Hwy Lake Leelanau MI 49653-9778 Ph: (231) 256-0606 |
| NPI Number | 1013109214 |
|---|---|
| Provider Enumeration Date | 08/13/2007 |
| Last Update Date | 08/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013109214 | NPI | - | NPPES |
| 4849101 | Medicaid | MI | |
| 1164458295 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 5101016681 (Michigan) | Primary |