=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356559041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDMICHIGAN CARDIOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 10/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 E WACKERLY ST SUITE D
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48642-7001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-832-0100
-----------------------------------------------------
Fax | 989-923-1055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 E WACKERLY ST SUITE D
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48642-7001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-832-0100
-----------------------------------------------------
Fax | 989-923-1055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NATHANIEL RHODE WOODRUFF
-----------------------------------------------------
Credential | M.D., PH.D.
-----------------------------------------------------
Telephone | 989-832-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 4301065098
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------