NPIMap

Organization Active NPI

Secret Forest Country Doctor

  • Family Medicine Physician
  • Central Lake, MI
National Provider Identifier
1447967153
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SECRET FOREST COUNTRY DOCTOR
Practice address
493 N Derenzy Rd
Central Lake, MI 49622-9566
Phone
(231) 544-7001
Fax
(231) 600-7054
NPI assigned
Nov 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Authorized official

Name
Gloria Witt, MDNPI 1851715536
Title
President
Phone
(231) 544-7001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

493 N Derenzy Rd
Central Lake, MI 49622-9566

Mailing address

493 N Derenzy Rd
Central Lake, MI 49622-9566
Phone (231) 544-7001

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1447967153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "493 N DERENZY RD",
            "city": "CENTRAL LAKE",
            "state": "MI",
            "postal_code": "496229566",
            "telephone_number": "231-544-7001",
            "fax_number": "231-600-7054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 N DERENZY RD",
            "city": "CENTRAL LAKE",
            "state": "MI",
            "postal_code": "496229566",
            "telephone_number": "231-544-7001",
            "fax_number": "231-600-7054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECRET FOREST COUNTRY DOCTOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-02",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "WITT",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-544-7001",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Central Lake, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; 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.