Provider Demographics
NPI:1245497858
Name:NORTHWEST MICHIGAN HEART & VASCULAR SPECIALISTS
Entity type:Organization
Organization Name:NORTHWEST MICHIGAN HEART & VASCULAR SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-935-0335
Mailing Address - Street 1:2393 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-0001
Mailing Address - Country:US
Mailing Address - Phone:231-935-0335
Mailing Address - Fax:231-935-0336
Practice Address - Street 1:3529 W FRONT ST
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9689
Practice Address - Country:US
Practice Address - Phone:231-935-0335
Practice Address - Fax:231-935-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075408207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0602810871OtherBCBS OF MICH
MI1245497858OtherCORP NPI
MI1407890536OtherINDIVIDUAL NPI
MI1407890536Medicaid
MI0281087OtherBLUE CARE NETWORK
MI0281087OtherBCBS OF MICH
MI0602810871OtherBLUE CARE NETWORK
MI1245497858Medicaid
MI1245497858OtherCORP NPI
MI1407890536OtherINDIVIDUAL NPI
MI0281087OtherBLUE CARE NETWORK