Provider Demographics
NPI:1558420240
Name:CENTRAL MICHIGAN UROLOGY CENTER PC
Entity Type:Organization
Organization Name:CENTRAL MICHIGAN UROLOGY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:BHARDWAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-772-4051
Mailing Address - Street 1:1111 S MISSION
Mailing Address - Street 2:STE 1
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-772-4051
Mailing Address - Fax:989-773-3265
Practice Address - Street 1:1111 S MISSION
Practice Address - Street 2:STE 1
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-772-4051
Practice Address - Fax:989-773-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430104U214208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI340C710990OtherBCBS
MI4700571Medicaid
B49059Medicare UPIN
MI4700571Medicaid