Medical school: MEDICAL COLLEGE OF WISCONSIN
Graduated: 1995
NPI: 1063450526
Practice Locations (2)
PORTAGE PHYSICIAN PRACTICES INC
500 CAMPUS DR
HANCOCK, MI 499301452
PORTAGE PHYSICIAN PRACTICES INC
500 CAMPUS DR
HANCOCK, MI 499301569
Source: CMS National Downloadable File, September 2026.