1649224627 NPI number — MID-MICHIGAN KIDNEY AND HYPERTENSION SPECIALISTS, P.C.

Table of content: (NPI 1649224627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649224627 NPI number — MID-MICHIGAN KIDNEY AND HYPERTENSION SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-MICHIGAN KIDNEY AND HYPERTENSION SPECIALISTS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649224627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1711 MOMENTUM PL
Provider Second Line Business Mailing Address:
LOCKBOX NUMBER 231711
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60689-5317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-732-5482
Provider Business Mailing Address Fax Number:
810-720-0301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5080 VILLA LINDE PKWY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-720-0162
Provider Business Practice Location Address Fax Number:
810-720-0301
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIRCHANDANI
Authorized Official First Name:
JAGDISH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-720-0162

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  4301062608 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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