Healthcare Provider Details

I. General information

NPI: 1740473396
Provider Name (Legal Business Name): CARDIOLOGY AND VASCULAR ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42557 WOODWARD AVE SUITE 200
BLOOMFIELD HILLS MI
48304-5206
US

IV. Provider business mailing address

42557 WOODWARD AVE SUITE 120
BLOOMFIELD HILLS MI
48304-5206
US

V. Phone/Fax

Practice location:
  • Phone: 248-333-1170
  • Fax: 248-333-1175
Mailing address:
  • Phone: 248-322-0083
  • Fax: 248-322-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704192792
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704167009
License Number StateMI

VIII. Authorized Official

Name: JAMES J ALUIA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 248-322-0083