Provider Demographics
NPI:1669791083
Name:THORACIC SURGERY INSTITUTE OF SOUTHWEST MICHIGAN PLC
Entity type:Organization
Organization Name:THORACIC SURGERY INSTITUTE OF SOUTHWEST MICHIGAN PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLEESON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-441-0444
Mailing Address - Street 1:2845 CAPITAL AVE SW
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4185
Mailing Address - Country:US
Mailing Address - Phone:269-441-0444
Mailing Address - Fax:269-441-0440
Practice Address - Street 1:2845 CAPITAL AVE SW
Practice Address - Street 2:SUITE 115
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4185
Practice Address - Country:US
Practice Address - Phone:269-441-0444
Practice Address - Fax:269-441-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITG013146208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty