Provider Demographics
NPI:1952317646
Name:MIDWEST CARDIOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:MIDWEST CARDIOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BACK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-261-9211
Mailing Address - Street 1:30626 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1870
Mailing Address - Country:US
Mailing Address - Phone:734-261-9211
Mailing Address - Fax:734-261-8537
Practice Address - Street 1:30626 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1870
Practice Address - Country:US
Practice Address - Phone:734-261-9211
Practice Address - Fax:734-261-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWB006125207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4591495Medicaid
MI4591495Medicaid
MIE26859Medicare UPIN