Healthcare Provider Details

I. General information

NPI: 1437585106
Provider Name (Legal Business Name): ELIAS H KASSAB MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 AUTO CLUB DR STE 300
DEARBORN MI
48126-2619
US

IV. Provider business mailing address

1360 PORTER ST SUITE 100
DEARBORN MI
48124-2823
US

V. Phone/Fax

Practice location:
  • Phone: 313-724-9000
  • Fax: 313-562-9300
Mailing address:
  • Phone: 313-724-9000
  • Fax: 313-562-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301047006
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301047006
License Number StateMI

VIII. Authorized Official

Name: ELIAS H KASSAB
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 313-724-9000