MEDICARE: APHERESIS AND TRANSFUSION MEDICINE OF PORT HURON PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZB0001X	Blood Banking & Transfusion Medicine Physician	4301079814	MI

General Provider Information

NPI Number	:	1316110968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APHERESIS AND TRANSFUSION MEDICINE OF PORT HURON PLLC

Provider Business Mailing Address
First Line	:	2601 ELECTRIC AVENUE
Second Line	:	MERCY HOSPITAL PORT HURON
City	:	PORT HURON
State	:	MI
Zip	:	48060
Country	:	US
Telephone Number	:	810-989-0979
Fax Number	:	810-385-4518

Provider Business Practice Location Address
First Line	:	4970 LAKESHORE ROAD
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059
Country	:	US
Telephone Number	:	810-488-1970
Fax Number	:	810-385-4518

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PRIYA KRISHEN
Credential	:	M.D.
Telephone Number	:	810-989-0979

Provider Enumeration Date	:	04/03/2008
Last Update Date	:	04/03/2008

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