Organization
PEDIATRIC CARDIOLOGY OF MICHIANA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY SPECKHARD (OFFICE MANAGER)
(574) 232-3325
Entity
Organization
Contact information
Practice address
707 N MICHIGAN ST, SUITE 316, SOUTH BEND, IN 46601-1067
(574) 232-3325
(574) 232-3358
Mailing address
707 N MICHIGAN ST, SUITE 316, SOUTH BEND, IN 46601-1067
(574) 232-3325
(574) 232-3358
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
01034696A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000330797001
BLUE CROSS BLUE SHIELD IN
IN
05
—
100475760A
—
IN
01
—
1761550
CIGNA
—
01
—
4564274
AETNA
—
Enumeration date
04/02/2007
Last updated
06/17/2008
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