Provider Demographics
NPI:1417016502
Name:KALAMAZOO CARDIOLOGY PC
Entity Type:Organization
Organization Name:KALAMAZOO CARDIOLOGY PC
Other - Org Name:BATTLE CREEK CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-381-3521
Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1650
Mailing Address - Country:US
Mailing Address - Phone:269-381-3521
Mailing Address - Fax:269-381-4703
Practice Address - Street 1:363 FREMONT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3389
Practice Address - Country:US
Practice Address - Phone:269-965-3521
Practice Address - Fax:269-965-8715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KALAMAZOO CARDIOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB0388OtherRAILROAD MEDICARE