Healthcare Provider Details

I. General information

NPI: 1043455058
Provider Name (Legal Business Name): CARDIAC AND VASCULAR ASSOCIATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43344 WOODWARD AVE STE. 111
BLOOMFIELD HILLS MI
48302-5049
US

IV. Provider business mailing address

645 BARCLAY CIR
ROCHESTER HILLS MI
48307-5804
US

V. Phone/Fax

Practice location:
  • Phone: 248-333-1170
  • Fax: 248-333-1175
Mailing address:
  • Phone: 248-844-1010
  • Fax: 248-844-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KIRITKUMAR C PATEL
Title or Position: OWNER REPRESENTATIVE
Credential: M.D.
Phone: 248-333-1170