Provider Demographics
NPI:1598954836
Name:MIDMICHIGAN CARDIOLOGY, PC
Entity Type:Organization
Organization Name:MIDMICHIGAN CARDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:ROHDE
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:989-832-0100
Mailing Address - Street 1:111 E WACKERLY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7043
Mailing Address - Country:US
Mailing Address - Phone:989-832-0100
Mailing Address - Fax:989-923-1055
Practice Address - Street 1:609 QUARTER ST
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1941
Practice Address - Country:US
Practice Address - Phone:989-246-6461
Practice Address - Fax:989-246-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINW065098174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3423708Medicaid
MI3423708Medicaid
MI0N88190Medicare PIN