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General NPI Number Information
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NPI Number | 1730461955
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Entity Type | Organization
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Legal Business Name | MIDWEST CARDIOVASCULAR CONSUTLANTS, LLC
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 5308 HARROUN RD SUITE 165
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City | SYLVANIA
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State | OH
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Zip | 43560-2114
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Country | US
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Telephone | 419-824-5162
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Fax | 419-885-3937
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Provider Business Mailing Address
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Address Line | 5308 HARROUN RD SUITE 165
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City | SYLVANIA
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State | OH
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Zip | 43560-2114
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Country | US
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Telephone | 419-824-5162
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Fax | 419-885-3937
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | AMY L BAHNSEN
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Credential |
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Telephone | 419-824-7334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | OH
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