Healthcare Provider Details

I. General information

NPI: 1689940397
Provider Name (Legal Business Name): HEART AND VASCULAR CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4771 MICHIGAN AVE
DETROIT MI
48210-3247
US

IV. Provider business mailing address

6959 BRUNSWICK DR
TROY MI
48085-1271
US

V. Phone/Fax

Practice location:
  • Phone: 313-897-2140
  • Fax: 313-897-2424
Mailing address:
  • Phone: 248-274-0169
  • Fax: 480-275-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine 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 NumberJP071846
License Number StateMI

VIII. Authorized Official

Name: MR. BABU S KONERU
Title or Position: SECRETARY
Credential:
Phone: 248-569-8989