Basic Information
| Provider Information | |||||||||
| NPI: | 1396725735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THORACIC AND CARDIOVASCULAR INSTITUTE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 S CEDAR ST | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489104699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178872511 | ||||||||
| FaxNumber: | 5178824144 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 W GREENLAWN AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489102898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174837570 | ||||||||
| FaxNumber: | 5174838403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 03/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | KRUGER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5174837580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.