KEVIN M OMILUSIK (NPI# 1679579122) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679579122 |
| Entity Type | Individual |
| Full Name | KEVIN M OMILUSIK |
| Credential | M.D. |
| Practice Address |
550 Munson Ave Traverse City MI 49686-3580 |
| Practice Telephone | 2319358686 |
| Practice Fax Number | 2319358708 |
| Mailing Telephone | 2319358686 |
| Mailing Fax Number | 2319358708 |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2019-04-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
4301065619 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
550 MUNSON AVE |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49686-3580 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205839131 | William H. George | Internal Medicine | 550 Munson Ave, Traverse City, MI 49686 | 2005-05-24 |
| 1265054936 | Erynne Louise Russell | Speech-Language Pathologist | 550 Munson Ave, Traverse City, MI 49686-3580 | 2020-05-15 |
| 1821624545 | Susan Carol Spencer | Speech-Language Pathologist | 550 Munson Ave, Traverse City, MI 49686-3580 | 2020-03-13 |
| 1346807617 | Mary Priestly | Physician Assistant | 550 Munson Ave, Traverse City, MI 49686-3580 | 2019-05-22 |
| 1194380493 | Kimberly A Chandler | Health Educator | 550 Munson Ave, Traverse City, MI 49686-3580 | 2019-05-02 |
| 1942770946 | Caroline Kiley | Physical Therapist | 550 Munson Ave, Traverse City, MI 49686-3580 | 2018-12-03 |
| 1851861850 | Grace Blankenhagen | Physical Therapist | 550 Munson Ave, Traverse City, MI 49686-3580 | 2018-12-03 |
| 1316429863 | Elizabeth Marie Teklinski | Counselor | 550 Munson Ave, Traverse City, MI 49686-3580 | 2018-08-31 |
| 1326544230 | Kaitlyn Troutman | Nurse Practitioner | 550 Munson Ave, Traverse City, MI 49686-3580 | 2018-04-02 |
| 1598267254 | Teresa Lynn Hearne | Physical Therapist | 550 Munson Ave, Traverse City, MI 49686-3580 | 2018-03-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245877208 | Jessica Marie Glowacki | Behavior Technician | 935 Hemlock St, Traverse City, MI 49686 | 2019-12-09 |
| 1568011542 | Joanne Kressley | Technician | 1693 Maylane Apt. 104, Traverse City, MI 49686 | 2019-09-11 |
| 1194283846 | Pace North | PACE Provider Organization | 2325 Garfield Road N., Traverse City, MI 49686 | 2019-03-12 |
| 1245749225 | Margaret Anne Goss | Speech-Language Pathologist | 1105 E. Eighth Street, Traverse City, MI 49686 | 2017-09-22 |
| 1467981811 | Joan Joyce Shirilla | Social Worker | 2124 Twin Eagles Dr, Traverse City, MI 49686 | 2017-06-08 |
| 1770028763 | Rehab and Mobility Systems, LLC | Durable Medical Equipment & Medical Supplies | 707 Parsons, Traverse City, MI 49686 | 2016-12-29 |
| 1629511316 | Kaitlyn Grangood | Social Worker | 415 Munson Avenue, Ste 101, Traverse City, MI 49686 | 2016-11-29 |
| 1811441132 | Jeffrey D Goodwin | Counselor | 430 Fair St., Traverse City, MI 49686 | 2016-08-04 |
| 1053779918 | Thomas Osborne | Counselor | 2014 Phelps Rd., Traverse City, MI 49686 | 2016-02-08 |
| 1982079588 | Marsha Lynne Dallas | Counselor | 2240 South Airport Road, Traverse City, MI 49686 | 2015-12-08 |
| Find all providers in zip 49686 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912973389 | Sara L Roth | Emergency Medicine | 1105 6th Street, Traverse City, MI 49684 | 2006-02-27 |
| 1154764348 | Brandi Jenks Gunn | Emergency Medicine | 1105 6th St, Traverse City, MI 49684-2345 | 2013-04-08 |
| 1306084405 | Patient Care Specialists Plc | Emergency Medicine | 1105 6th St, Traverse City, MI 49684-2345 | 2009-01-27 |
| 1790769669 | Indigo Services, Plc | Emergency Medicine | 1105 6th St, Traverse City, MI 49684-2349 | 2005-12-02 |
| 1649276759 | John B Schroeder | Emergency Medicine | 1105 6th St, Traverse City, MI 49684-2349 | 2005-06-23 |
| 1174529606 | Richard G Faller | Emergency Medicine | 1105 6th St, Traverse City, MI 49684-2349 | 2005-06-21 |
| 1497751929 | Julie K Johnson | Emergency Medicine | 1105 6th St, Traverse City, MI 49684-2349 | 2005-06-21 |
| 1730185273 | Marc S Krakow | Emergency Medicine | 1105 6th St, Traverse City, MI 49684-2349 | 2005-06-21 |
| 1619973153 | Mark A Mikula | Emergency Medicine | 1105 6th St, Traverse City, MI 49684-2349 | 2005-06-21 |
| 1225034762 | Curt M Mikulski | Emergency Medicine | 1105 6th St, Traverse City, MI 49684-2349 | 2005-06-21 |
| Find all providers in TRAVERSE CITY | ||||
| City | TRAVERSE CITY |
| Zip Code | 49686 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.