Organization
MICHIGAN PEDIATRIC CARDIOVASCULAR SURGEONS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY LANE WALTERS III M.D. (PRESIDENT)
(313) 745-5538
Entity
Organization
Contact information
Practice address
3901 BEAUBIEN BLVD, DETROIT, MI 48201-2119
(313) 745-5538
(313) 993-0531
Mailing address
PO BOX 441097, DETROIT, MI 48244-1097
(313) 745-5538
(313) 993-0531
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Enumeration date
05/23/2006
Last updated
08/22/2020
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