Healthcare Provider Details

I. General information

NPI: 1457536336
Provider Name (Legal Business Name): CARDIOTHORACIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N MICHIGAN ST SUITE 501
SOUTH BEND IN
46601-1067
US

IV. Provider business mailing address

707 N MICHIGAN ST SUITE 501
SOUTH BEND IN
46601-1067
US

V. Phone/Fax

Practice location:
  • Phone: 574-237-0644
  • Fax: 574-234-6986
Mailing address:
  • Phone: 574-237-0644
  • Fax: 574-234-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number01037310
License Number StateIN

VIII. Authorized Official

Name: MRS. TAMMY K ALBRIGHT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 574-237-0644