Healthcare Provider Details

I. General information

NPI: 1477845824
Provider Name (Legal Business Name): EHK ENDOVASCULAR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 AUTO CLUB DR STE 170
DEARBORN MI
48126-2619
US

IV. Provider business mailing address

5250 AUTO CLUB DR STE 170
DEARBORN MI
48126-2619
US

V. Phone/Fax

Practice location:
  • Phone: 313-359-8300
  • Fax: 313-359-8305
Mailing address:
  • Phone: 313-359-8300
  • Fax: 313-359-8036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301047006
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301047006
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIAS H KASSAB
Title or Position: OWNER
Credential: M.D.
Phone: 313-359-8300