Healthcare Provider Details

I. General information

NPI: 1407067051
Provider Name (Legal Business Name): OWOSSO HEART INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E M 21 RM 100
OWOSSO MI
48867-9047
US

IV. Provider business mailing address

1350 E M 21 RM 100
OWOSSO MI
48867-9047
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-9808
  • Fax:
Mailing address:
  • Phone: 989-729-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number510102740
License Number StateMI

VIII. Authorized Official

Name: SHERRIE BROOKS
Title or Position: OWNER
Credential: DO
Phone: 989-729-9808