Active NPI
Petoskey Surgeons, P.C.
- Surgery Physician
- Petoskey, MI
National Provider Identifier
1730145574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- PETOSKEY SURGEONS, P.C.
- Practice address
- 521 Monroe St
Petoskey, MI 49770-2266 - Phone
- (231) 487-1900
- Fax
- (231) 348-0984
- NPI assigned
- Apr 21, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kevin M. Markham, M.D.
- Title
- President
- Phone
- (231) 487-1900
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary | ||
| Vascular Surgery Physician | 2086S0129X |
Addresses
Primary practice location
521 Monroe St
Petoskey, MI 49770-2266
Mailing address
521 Monroe St
Petoskey, MI 49770-2266
Phone (231) 487-1900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020B41012 | Other | MI | BLUE CARE NETWORK |
| 020B41012 | Other | MI | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051230000532 | MI | Part B Supplier - Clinic/Group Practice | 4880616028 |
Receives reassigned benefits from 23 practitioners Practice locations: Cheboygan, MI; Gaylord, MI; Petoskey, MI; Saint Ignace, MI |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2157038 | Petoskey Surgeons, PC | Certificate of waiver | Oct 29, 2026 |
National Provider Directory
National Provider DirectoryLocations
14700 Park Ave
Charlevoix, MI 49720
Phone (231) 547-2812
829 N Center Ave
Ste 298
Gaylord, MI 49735
Phone (989) 731-7707
521 Monroe St
Petoskey, MI 49770
Phone (231) 348-1514
Practitioners & affiliated clinicians
Practitioners 50
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": "1145577600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1339027200000",
"number": "1730145574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "521 MONROE ST",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497702266",
"telephone_number": "231-487-1900",
"fax_number": "231-348-0984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "521 MONROE ST",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497702266",
"telephone_number": "231-487-1900",
"fax_number": "231-348-0984"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PETOSKEY SURGEONS, P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-04-21",
"last_updated": "2012-06-07",
"status": "A",
"authorized_official_last_name": "MARKHAM",
"authorized_official_first_name": "KEVIN",
"authorized_official_middle_name": "M.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "231-487-1900",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
},
{
"code": "2086S0129X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery, Vascular Surgery",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "020B41012",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "020B41012",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Petoskey, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.