Healthcare Provider Details

I. General information

NPI: 1831154798
Provider Name (Legal Business Name): AMIR K KAKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST SUITE 510
DETROIT MI
48201-2020
US

IV. Provider business mailing address

4160 JOHN R ST SUITE 510
DETROIT MI
48201-2020
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-7777
  • Fax: 313-993-7777
Mailing address:
  • Phone: 313-993-7777
  • Fax: 313-993-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number249372
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number249372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: