Provider Demographics
NPI:1275695587
Name:MICHIGAN CARDIOLOGY PC
Entity Type:Organization
Organization Name:MICHIGAN CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:HENNIG
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:810-720-7167
Mailing Address - Street 1:G 1386 SOUTH LINDEN
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-720-7167
Mailing Address - Fax:810-720-7172
Practice Address - Street 1:G 1386 SOUTH LINDEN
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-720-1720
Practice Address - Fax:810-720-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
060B51089OtherBLUE CROSS
CN9425OtherMEDICARE RAILROAD
CN9425OtherMEDICARE RAILROAD