Healthcare Provider Details

I. General information

NPI: 1043676661
Provider Name (Legal Business Name): INTEGRATIVE CARDIOVASCULAR HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 WOODS WAY
PETOSKEY MI
49770-8694
US

IV. Provider business mailing address

3280 WOODS WAY UNIT 3
PETOSKEY MI
49770-8105
US

V. Phone/Fax

Practice location:
  • Phone: 231-348-3800
  • Fax: 231-348-3804
Mailing address:
  • Phone: 231-348-3800
  • Fax: 231-348-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: ANDRIS KAZMERS
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 231-881-9700