Common Contracts

4 similar Practitioner Affiliation Agreement contracts

PRACTITIONER AFFILIATION AGREEMENT
Practitioner Affiliation Agreement • November 8th, 2022 • Michigan

This Agreement is made by and between BLUE CROSS AND BLUE SHIELD OF MICHIGAN, a Michigan nonprofit healthcare corporation (BCBSM), and the undersigned Practitioner who is fully licensed or legally authorized to practice in the state of Michigan (TRUST PRACTITIONER).

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PRACTITIONER AFFILIATION AGREEMENT
Practitioner Affiliation Agreement • May 19th, 2016 • Michigan

This Agreement is made by and between BLUE CROSS AND BLUE SHIELD OF MICHIGAN, a Michigan nonprofit healthcare corporation (BCBSM), and the undersigned Practitioner who is fully licensed or legally authorized to practice in the state of Michigan (TRUST PRACTITIONER).

PRACTITIONER AFFILIATION AGREEMENT
Practitioner Affiliation Agreement • June 30th, 2015 • Michigan

This Agreement is made by and between BLUE CROSS AND BLUE SHIELD OF MICHIGAN, a Michigan nonprofit healthcare corporation (BCBSM), and the undersigned Practitioner who is fully licensed or legally authorized to practice in the state of Michigan (TRUST PRACTITIONER).

PRACTITIONER AFFILIATION AGREEMENT FOR
Practitioner Affiliation Agreement • September 3rd, 2010 • Michigan

This Agreement is made by and between BLUE CROSS AND BLUE SHIELD OF MICHIGAN, a Michigan nonprofit healthcare corporation (BCBSM), and the undersigned Practitioner who is fully licensed or legally authorized to practice in the state of Michigan (TRUST PRACTITIONER).

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