Provider Demographics
NPI:1164296380
Name:WEST MICHIGAN CARDIOLOGY, PC
Entity Type:Organization
Organization Name:WEST MICHIGAN CARDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEJINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-456-9553
Mailing Address - Street 1:3210 EAGLE RUN DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7051
Mailing Address - Country:US
Mailing Address - Phone:616-456-9553
Mailing Address - Fax:616-454-5371
Practice Address - Street 1:3210 EAGLE RUN DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7051
Practice Address - Country:US
Practice Address - Phone:616-456-9553
Practice Address - Fax:616-454-5371
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST MICHIGAN CARDIOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC3500XNursing Service ProvidersRegistered NurseCardiac RehabilitationGroup - Single Specialty
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac FacilitiesGroup - Single Specialty