Healthcare Provider Details

I. General information

NPI: 1679797195
Provider Name (Legal Business Name): CARDIOTHORACIC SURGEONS OF G.T.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 6TH ST SUITE 202
TRAVERSE CITY MI
49684-2359
US

IV. Provider business mailing address

1221 6TH ST SUITE 202
TRAVERSE CITY MI
49684-2359
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-5730
  • Fax: 231-935-5736
Mailing address:
  • Phone: 231-935-5730
  • Fax: 231-935-5736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARONE K NORMAN
Title or Position: OFFICE MGR
Credential:
Phone: 231-935-5730