Healthcare Provider Details

I. General information

NPI: 1023098191
Provider Name (Legal Business Name): MICHIGAN CARDIOVASCULAR INSTITUTE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S WASHINGTON AVE
SAGINAW MI
48601-2556
US

IV. Provider business mailing address

1015 S WASHINGTON AVE
SAGINAW MI
48601-2556
US

V. Phone/Fax

Practice location:
  • Phone: 989-754-3000
  • Fax: 989-755-1365
Mailing address:
  • Phone: 989-754-3000
  • Fax: 989-755-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM HARDIMON
Title or Position: CEO
Credential: MBA
Phone: 989-754-3000