Provider Demographics
NPI:1780724468
Name:MID-MICHIGAN CARDIOLOGY ASSOCIATES PLC
Entity type:Organization
Organization Name:MID-MICHIGAN CARDIOLOGY ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-732-5400
Mailing Address - Street 1:1165 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3406
Mailing Address - Country:US
Mailing Address - Phone:810-732-5400
Mailing Address - Fax:810-733-1624
Practice Address - Street 1:1165 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3406
Practice Address - Country:US
Practice Address - Phone:810-732-5400
Practice Address - Fax:810-733-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMA038827174400000X
MIER039365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N88450Medicare PIN