Provider Demographics
NPI:1316110968
Name:APHERESIS AND TRANSFUSION MEDICINE OF PORT HURON PLLC
Entity type:Organization
Organization Name:APHERESIS AND TRANSFUSION MEDICINE OF PORT HURON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-989-0979
Mailing Address - Street 1:2601 ELECTRIC AVENUE
Mailing Address - Street 2:MERCY HOSPITAL PORT HURON
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:810-989-0979
Mailing Address - Fax:810-385-4518
Practice Address - Street 1:4970 LAKESHORE ROAD
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059
Practice Address - Country:US
Practice Address - Phone:810-488-1970
Practice Address - Fax:810-385-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079814207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty