OrganizationActive
Northridge Family Practice LLC
NPI 1780803932 · Clinical Cardiac Electrophysiology Physician · Hale, MI
Provider details
- NPI number
- 1780803932
- Entity type
- Organization
- Primary specialty
- Clinical Cardiac Electrophysiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Debra Provoast, Owner(989) 728-6000
- License
- 4301061417 (MI)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
3190 Northridge Drive
Hale, MI 48739-9276
Phone: (989) 728-6000
Fax: (989) 728-6003
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 279
Hale, MI 48739-0279
Registry dates
- Enumerated
- 2007-04-25
- Last updated
- 2009-01-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.