NPIMap

Organization Active NPI

Clinical Practice Managers and Consultants of Northwest Michigan PLLC

Doing business as The Renaissance Medical Clinic

  • Internal Medicine Physician
  • Lake City, MI
National Provider Identifier
1689716557
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CLINICAL PRACTICE MANAGERS AND CONSULTANTS OF NORTHWEST MICHIGAN PLLC
Doing business as
The Renaissance Medical Clinic
Practice address
112 John Street
Lake City, MI 49601
Phone
(231) 839-4359
Fax
(231) 839-0223
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Sotero Ureta, M.D.NPI 1174545271
Title
President
Phone
(231) 839-4359

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
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

112 John Street
Lake City, MI 49601

Mailing address

PO Box 213
Cadillac, MI 49601-0213
Phone (231) 775-6076

Other names 1

  • The Renaissance Medical Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

112 E John St
Lake City, MI 49651
Phone (231) 839-4359

Practitioners & affiliated clinicians

Practitioners 2

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689716557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 213",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496010213",
            "telephone_number": "231-775-6076",
            "fax_number": "231-775-0027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 JOHN STREET",
            "city": "LAKE CITY",
            "state": "MI",
            "postal_code": "49601",
            "telephone_number": "231-839-4359",
            "fax_number": "231-839-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL PRACTICE MANAGERS AND CONSULTANTS OF NORTHWEST MICHIGAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "URETA",
        "authorized_official_first_name": "SOTERO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-839-4359",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Renaissance Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.