MEDICARE: CARDIAC AND VASCULAR ASSOCIATION PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RC0001X	Clinical Cardiac Electrophysiology Physician
2	207RI0011X	Interventional Cardiology Physician
3	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F38249	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1043455058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC AND VASCULAR ASSOCIATION PC

Provider Business Mailing Address
First Line	:	645 BARCLAY CIR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5804
Country	:	US
Telephone Number	:	248-844-1010
Fax Number	:	248-844-8098

Provider Business Practice Location Address
First Line	:	43344 WOODWARD AVE
Second Line	:	STE. 111
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5049
Country	:	US
Telephone Number	:	248-333-1170
Fax Number	:	248-333-1175

Authorized Official
Title or Position	:	OWNER REPRESENTATIVE
Name	:	KIRITKUMAR C PATEL
Credential	:	M.D.
Telephone Number	:	248-333-1170

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	03/04/2010

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