Michigan Pediatric Cardiovascular Surgeons PC

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

Legal business name

MICHIGAN PEDIATRIC CARDIOVASCULAR SURGEONS PC

Practice address

3901 Beaubien Blvd
Detroit, MI 48201-2119

Phone

(313) 745-5538

Fax

(313) 993-0531

NPI assigned

May 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Henry Lane Walters III, M.D.

Title

President

Phone

(313) 745-5538

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619922176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 441097",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482441097",
            "telephone_number": "313-745-5538",
            "fax_number": "313-993-0531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 BEAUBIEN BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012119",
            "telephone_number": "313-745-5538",
            "fax_number": "313-993-0531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN PEDIATRIC CARDIOVASCULAR SURGEONS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "LANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-745-5538",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michigan Institute for Prevention and Intervention
• Michigan Magical
• Michigan Medical Mall
• Michigan Medical Specialists PC
• Michigan Pain&Spine Clinic PLLC
• Michigan Pediatric Surgery Associates P.C.
• Michigan Physical Therapy
• Michigan Providers LLC
• Michigan Recovery and Wellness Initive
• Michigan Rehabilitation Physicians

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.