Healthcare Provider Details

I. General information

NPI: 1861572810
Provider Name (Legal Business Name): CARDIOLOGY SOUTHWEST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 N SAINT JOSEPH AVE
NILES MI
49120-2207
US

IV. Provider business mailing address

61 N SAINT JOSEPH AVE
NILES MI
49120-2207
US

V. Phone/Fax

Practice location:
  • Phone: 269-684-6777
  • Fax: 269-683-5384
Mailing address:
  • Phone: 269-684-6777
  • Fax: 269-683-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberJH009955
License Number StateMI

VIII. Authorized Official

Name: MRS. JULIE SHEARER
Title or Position: MEDICAL BILLING
Credential:
Phone: 269-684-6777