Northshore Medical Clinic P C

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

5101005875 Issued in MI

Legal business name

NORTHSHORE MEDICAL CLINIC P C

Practice address

7786 Mullett Lake Rd
Cheboygan, MI 49721-9056

Phone

(231) 627-2869

Fax

(231) 627-2869

NPI assigned

Jan 2, 2007

Last updated

Dec 19, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jerome E Siudara, D.O.NPI 1598941346

Title

Physician

Phone

(231) 627-2869

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jerome E Siudara, D.O.

  • Gynecology Physician
  • Cheboygan, MI
  • NPI 1598941346
  NPD (past) Authorized official

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229644800000",
    "number": "1841357464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7786 MULLETT LAKE RD",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497219056",
            "telephone_number": "231-627-2869",
            "fax_number": "231-627-2869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7786 MULLETT LAKE RD",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497219056",
            "telephone_number": "231-627-2869",
            "fax_number": "231-627-2869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE MEDICAL CLINIC P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2008-12-19",
        "status": "A",
        "authorized_official_last_name": "SIUDARA",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "231-627-2869",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5101005875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS OF MI",
            "identifier": "1651630495",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111350021",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northern Michigan Dermatology PC
• Northern Michigan Family Dentistry PLLC (Cheboygan Family Dentistry)
• Northern Michigan Regional Hospital
• Northern Michigan Regional Hospital
• Northern Radiology, PC
• Bethanie Norton-Boss
• Kathleen Nummerdor, LPTA
• Daniel Martin Orr, PT
• Stacey Ostrowski, MS, ATC
• Stacy Oxley

• Obstetrics & Gynecology Physician in Cheboygan, MI
• Providers in Cheboygan, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2008; 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.