Provider Demographics
NPI:1669524963
Name:MICHIGAN HEART CENTER PC
Entity type:Organization
Organization Name:MICHIGAN HEART CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CURTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-343-0980
Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1650
Mailing Address - Country:US
Mailing Address - Phone:269-343-0980
Mailing Address - Fax:269-343-4208
Practice Address - Street 1:1535 GULL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1650
Practice Address - Country:US
Practice Address - Phone:269-343-0980
Practice Address - Fax:269-343-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035735261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0393217OtherBLUE CROSS BLUE SHIELD OF MI
MI101252559Medicaid
MI1679512636OtherINDIVIDUAL NPI ID NUMBER
MIA78393Medicare UPIN
MI101252559Medicaid