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General NPI Number Information
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NPI Number | 1821369307
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Entity Type | Organization
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Legal Business Name | MIDWEST CARDIOVASCULAR CONSULTANTS LLC
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 01/16/2012
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Provider Practice Location Address
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Address Line | 1250 RALSTON AVE SUITE 203A
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City | DEFIANCE
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State | OH
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Zip | 43512-5311
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Country | US
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Telephone | 419-783-6895
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Fax | 419-782-4459
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Provider Business Mailing Address
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Address Line | 1250 RALSTON AVE SUITE 203A
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City | DEFIANCE
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State | OH
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Zip | 43512-5311
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Country | US
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Telephone | 419-783-6895
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Fax | 419-782-4459
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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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