Organization
GREATER NILES CARDIOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY L FORTUNE (OFFICE MANAGER)
(269) 687-9575
Entity
Organization
Contact information
Practice address
24 N SAINT JOSEPH AVE, SUITE F1, NILES, MI 49120-2263
(269) 687-9575
(269) 687-9596
Mailing address
24 N SAINT JOSEPH AVE, SUITE F1, NILES, MI 49120-2263
(269) 687-9575
(269) 687-9596
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301079120
MI
Other
Enumeration date
11/05/2013
Last updated
01/08/2014
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