Healthcare Provider Details

I. General information

NPI: 1669524963
Provider Name (Legal Business Name): MICHIGAN HEART CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 GULL RD SUITE 210
KALAMAZOO MI
49048-1650
US

IV. Provider business mailing address

1535 GULL RD SUITE 210
KALAMAZOO MI
49048-1650
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-0980
  • Fax: 269-343-4208
Mailing address:
  • Phone: 269-343-0980
  • Fax: 269-343-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4301035735
License Number StateMI

VIII. Authorized Official

Name: MRS. STEPHANIE A CURTICE
Title or Position: OFFICE MANAGER
Credential:
Phone: 269-343-0980