Healthcare Provider Details

I. General information

NPI: 1396725735
Provider Name (Legal Business Name): THORACIC AND CARDIOVASCULAR INSTITUTE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GREENLAWN AVE SUITE 400
LANSING MI
48910-2898
US

IV. Provider business mailing address

3500 S CEDAR ST SUITE 116
LANSING MI
48910-4699
US

V. Phone/Fax

Practice location:
  • Phone: 517-483-7570
  • Fax: 517-483-8403
Mailing address:
  • Phone: 517-887-2511
  • Fax: 517-882-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. DAVID KRUGER
Title or Position: CEO
Credential:
Phone: 517-483-7580