Provider Demographics
NPI:1518076637
Name:CARDIAC SURGERY INSTITUTE PC
Entity Type:Organization
Organization Name:CARDIAC SURGERY INSTITUTE PC
Other - Org Name:CARDIAC AND THORACIC SURGERY INSTITUTE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIJAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MINANOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-493-9229
Mailing Address - Street 1:1030 HARRINGTON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2967
Mailing Address - Country:US
Mailing Address - Phone:586-493-9229
Mailing Address - Fax:586-493-4396
Practice Address - Street 1:1030 HARRINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043
Practice Address - Country:US
Practice Address - Phone:586-493-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M29150Medicare ID - Type Unspecified