Organization
HEALTHCARE MIDWEST PC
Active
Parent organization
HEALTHCARE MIDWEST, PC
Other names
LifeTime Wellness in Internal Medicine & Pediatrics A Division of Heal
Organization subpart
Yes
Provider details
NPI number
Legal business name
HEALTHCARE MIDWEST, PC
Authorized official
MR. JAMES E MCKERNAN (ADMINISTRATOR)
(269) 373-4646
Entity
Organization
Contact information
Practice address
4613 W MAIN ST, SUITE A, KALAMAZOO, MI 49006-2645
(269) 488-8672
(269) 488-8673
Mailing address
4341 S WESTNEDGE AVE, SUITE 2205, KALAMAZOO, MI 49008-3289
(269) 373-4646
(269) 373-7655
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110C913020
BLUE CROSS GRP PIN
MI
Enumeration date
05/01/2007
Last updated
08/11/2010
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