Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Northridge Family Practice LLC

Organization Internal Medicine Physician · NPI 1891712493

Northridge Family Practice LLC is an Internal Medicine Physician in Hale, Michigan. Licensed in Michigan. Registered with an NPI since 2006.

Licensed in
MI
In the registry since
2006
Specialties on file
5
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

3190 Northridge Dr
Hale, MI 48739-9276
Phone: (989) 728-6000
Fax: (989) 728-6003
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 4704173663 (MI)
Internal Medicine Physician Taxonomy 207R00000X · Licence 4301061417 (MI)
Nurse Practitioner Taxonomy 363L00000X · Licence 4704148660 (MI)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 4704245250 (MI)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 4704283185 (MI)

Record details

NPI number1891712493
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Debra Provoast — Managing Officer · (989) 728-6000
NPI enumeratedJuly 17, 2006
Last updated in NPPESNovember 2, 2015
Mailing addressPo Box 279, Hale, MI 48739-0279

Other providers in Hale