Active NPI
Gregory C Putalik, M.D.
- Family Medicine Physician
- Harbor Springs, MI
National Provider Identifier
1679782841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301050511
- Practice address
- 643 E Lake St
#4
Harbor Springs, MI 49740-1239 - Phone
- (231) 242-4734
- Fax
- (231) 242-4700
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301050511 | MI | Primary |
| Family Medicine Physician | 207Q00000X | 50511 | MI |
Addresses
Primary practice location
643 E Lake St
#4
Harbor Springs, MI 49740-1239
Mailing address
643 E Lake St
# 4
Harbor Springs, MI 49740-1239
Phone (231) 526-5041
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4081535 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50511 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Care Sports Medicine PC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Petoskey, MI
- NPI 1972658136
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344988800000",
"number": "1679782841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "643 E LAKE ST",
"address_2": "# 4",
"city": "HARBOR SPRINGS",
"state": "MI",
"postal_code": "497401239",
"telephone_number": "231-526-5041",
"fax_number": "231-242-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "643 E LAKE ST",
"address_2": "#4",
"city": "HARBOR SPRINGS",
"state": "MI",
"postal_code": "497401239",
"telephone_number": "231-242-4734",
"fax_number": "231-242-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUTALIK",
"first_name": "GREGORY",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2012-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301050511",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "50511",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4081535",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harbor Springs, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.