Provider Demographics
NPI:1790718823
Name:HARRY T COLFER CARDIAC CONSULTANTS
Entity Type:Organization
Organization Name:HARRY T COLFER CARDIAC CONSULTANTS
Other - Org Name:HARRY T COLFER CARDIOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:COLFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-2493
Mailing Address - Street 1:560 W MITCHELL ST STE 500
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2277
Mailing Address - Country:US
Mailing Address - Phone:231-487-2493
Mailing Address - Fax:231-487-2593
Practice Address - Street 1:560 W MITCHELL ST STE 500
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2277
Practice Address - Country:US
Practice Address - Phone:231-487-2493
Practice Address - Fax:231-487-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4085623Medicaid
MION49530Medicare ID - Type Unspecified
MI4085623Medicaid