Provider Demographics
NPI:1144416264
Name:HEALTHY HEART CARDIOLOGY, PLC
Entity Type:Organization
Organization Name:HEALTHY HEART CARDIOLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KHURANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-291-6952
Mailing Address - Street 1:3181 PRAIRIE ST SW
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2097
Mailing Address - Country:US
Mailing Address - Phone:616-291-6952
Mailing Address - Fax:866-966-9677
Practice Address - Street 1:3181 PRAIRIE ST SW
Practice Address - Street 2:SUITE 112
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2097
Practice Address - Country:US
Practice Address - Phone:616-291-6952
Practice Address - Fax:866-966-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053818207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1144416264Medicaid
MI0603410481OtherBCBS
MI0P61660Medicare PIN