Electro Spa of Northern Michigan

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

Legal business name

ELECTRO SPA OF NORTHERN MICHIGAN

Practice address

403 E State St Ste 100
Traverse City, MI 49686-5805

Phone

(231) 933-6001

Fax

(231) 947-1506

NPI assigned

Feb 17, 2010

Organization subpart

Yes

Parent organization

DANIEL M SARYA, DDS, MPH, PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Marguerite J Tilley

Title

Clinician

Phone

(231) 933-6001

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266364800000",
    "number": "1013239185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 E STATE ST STE 100",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496865805",
            "telephone_number": "231-933-6001",
            "fax_number": "231-947-1506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 E STATE ST STE 100",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496865805",
            "telephone_number": "231-933-6001",
            "fax_number": "231-947-1506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELECTRO SPA OF NORTHERN MICHIGAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DANIEL M SARYA, DDS, MPH, PC",
        "enumeration_date": "2010-02-17",
        "last_updated": "2010-02-17",
        "status": "A",
        "authorized_official_last_name": "TILLEY",
        "authorized_official_first_name": "MARGUERITE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "231-933-6001",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1528122207",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Other Specialist/Technologist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Other Specialist/Technologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.