Healthcare Provider Details

I. General information

NPI: 1578891735
Provider Name (Legal Business Name): FLAT ROCK CARDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29100 GATEWAY BOULEVARD SUITE 300
FLAT ROCK MI
48134
US

IV. Provider business mailing address

2764 RIVERSIDE DRIVE
TRENTON MI
48183
US

V. Phone/Fax

Practice location:
  • Phone: 734-379-0781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ANDREW KALATA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 734-675-8428