Provider Demographics
NPI:1144024332
Name:NORTH-STAR CARE OF MICHIGAN
Entity type:Organization
Organization Name:NORTH-STAR CARE OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-221-6113
Mailing Address - Street 1:1368 PILCHUCK HTS
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-9660
Mailing Address - Country:US
Mailing Address - Phone:855-302-9191
Mailing Address - Fax:
Practice Address - Street 1:1368 PILCHUCK HTS
Practice Address - Street 2:
Practice Address - City:FOX ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98333-9660
Practice Address - Country:US
Practice Address - Phone:855-302-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH-STAR CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-04
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty