MEDICARE: CARDIOLOGY GROUP OF LANSING P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060C310230	OTHER		BCBS

General Provider Information

NPI Number	:	1962469189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOLOGY GROUP OF LANSING P C

Provider Business Mailing Address
First Line	:	5894 MARENGO ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-8315
Country	:	US
Telephone Number	:	517-745-3403
Fax Number	:	517-482-3664

Provider Business Practice Location Address
First Line	:	2575 SPRING ARBOR RD STE 100
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3652
Country	:	US
Telephone Number	:	517-787-7844
Fax Number	:	517-783-5044

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	HARESH JANI
Credential	:	MD
Telephone Number	:	517-482-2020

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	03/21/2024

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