Northern Michigan Physical Medicine PLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

GK012925 Issued in MI

Legal business name

NORTHERN MICHIGAN PHYSICAL MEDICINE PLC

Practice address

2780 Charlevoix Ave
19
Petoskey, MI 49770-8058

Phone

(231) 347-9800

Fax

(231) 347-9850

NPI assigned

Nov 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gerald Klooster II, D.O.

Title

Officer

Phone

(231) 347-9800

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1043499353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2780 CHARLEVOIX AVE",
            "address_2": "19",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708058",
            "telephone_number": "231-347-9800",
            "fax_number": "231-347-9850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2780 CHARLEVOIX AVE",
            "address_2": "19",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708058",
            "telephone_number": "231-347-9800",
            "fax_number": "231-347-9850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN MICHIGAN PHYSICAL MEDICINE PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-02",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "KLOOSTER",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "231-347-9800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "GK012925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northern Michigan Medical Management
• Northern Michigan Musculoskeletal Medicine PLLC
• Northern Michigan Oral and Maxillofacial Surgery PC
• Northern Michigan Pain Specialists PC
• Northern Michigan Physical Medicine PC
• Northern Michigan Rehabilitation Specialists, P.C.
• Northern Michigan Rheumatology PC
• Northern Michigan Sports Medicine Center
• Northern Michigan Urology P.C.
• Northern Pathology Associates, PC

• Physical Medicine & Rehabilitation Physician in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.