Provider Demographics
NPI:1649224627
Name:MID-MICHIGAN KIDNEY AND HYPERTENSION SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:MID-MICHIGAN KIDNEY AND HYPERTENSION SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAGDISH
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRCHANDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-720-0162
Mailing Address - Street 1:1711 MOMENTUM PL
Mailing Address - Street 2:LOCKBOX NUMBER 231711
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5317
Mailing Address - Country:US
Mailing Address - Phone:810-732-5482
Mailing Address - Fax:810-720-0301
Practice Address - Street 1:5080 VILLA LINDE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3411
Practice Address - Country:US
Practice Address - Phone:810-720-0162
Practice Address - Fax:810-720-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062608207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty