Provider Demographics
NPI:1215997333
Name:MIDWEST CARDIOVASCULAR CONSULTANTS LLC
Entity type:Organization
Organization Name:MIDWEST CARDIOVASCULAR CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAHNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-7334
Mailing Address - Street 1:5855 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2269
Mailing Address - Country:US
Mailing Address - Phone:419-824-7221
Mailing Address - Fax:419-885-0064
Practice Address - Street 1:5855 MONROE ST
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2269
Practice Address - Country:US
Practice Address - Phone:419-824-7221
Practice Address - Fax:419-885-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7663459OtherAETNA
OH2421605Medicaid
OHDA2406OtherRRMC
OH7663459OtherAETNA