Provider Demographics
NPI:1649291873
Name:MICHIGAN HEART & VASCULAR SPECIALISTS, PC
Entity type:Organization
Organization Name:MICHIGAN HEART & VASCULAR SPECIALISTS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MBA
Authorized Official - Phone:231-487-9807
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2490
Mailing Address - Fax:231-487-6055
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2490
Practice Address - Fax:231-487-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG05370OtherBLUE CARE NETWORK
MIOB41013OtherBLUE SHIELD
MIOB41013OtherBLUE SHIELD