Provider Demographics
NPI:1164670774
Name:MID MICHIGAN FAMILY ORTHOPAEDICS PC
Entity type:Organization
Organization Name:MID MICHIGAN FAMILY ORTHOPAEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-345-7474
Mailing Address - Street 1:2333 PROGRESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9384
Mailing Address - Country:US
Mailing Address - Phone:989-345-7474
Mailing Address - Fax:989-345-7033
Practice Address - Street 1:2333 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9384
Practice Address - Country:US
Practice Address - Phone:989-345-7474
Practice Address - Fax:989-345-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045177207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty