Provider Demographics
NPI:1861958076
Name:PROMEDICA CENTRAL CORPORATION OF MICHIGAN
Entity type:Organization
Organization Name:PROMEDICA CENTRAL CORPORATION OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUEVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-585-1969
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1969
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:324 E MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2961
Practice Address - Country:US
Practice Address - Phone:517-265-3307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMEDICA PHYSICIAN GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty