Healthcare Provider Details

I. General information

NPI: 1003319096
Provider Name (Legal Business Name): MICHIGAN CANTON CARDIOLOGY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 N HAGGERTY RD STE B2
CANTON MI
48187-3795
US

IV. Provider business mailing address

1212 HIDDEN LAKE DR
BLOOMFLD HLS MI
48302-1955
US

V. Phone/Fax

Practice location:
  • Phone: 734-326-0740
  • Fax: 734-326-0785
Mailing address:
  • Phone: 734-729-6710
  • Fax: 734-729-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJESH GULATI
Title or Position: DIRECTOR
Credential: MD
Phone: 734-326-0740