Healthcare Provider Details

I. General information

NPI: 1104376581
Provider Name (Legal Business Name): EAST MICHIGAN CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 SUNCREST DR
LAPEER MI
48446-1136
US

IV. Provider business mailing address

1031 SUNCREST DR
LAPEER MI
48446-1136
US

V. Phone/Fax

Practice location:
  • Phone: 810-245-6111
  • Fax: 810-538-0070
Mailing address:
  • Phone: 810-245-6111
  • Fax: 810-538-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ABDUL ALAWWA
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 810-245-6111