Healthcare Provider Details

I. General information

NPI: 1194893081
Provider Name (Legal Business Name): CARDIOLOGY CONSULTANTS OF MICHIGAN & OHIO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N MACOMB ST STE #429
MONROE MI
48162-2900
US

IV. Provider business mailing address

730 N MACOMB ST STE 429
MONROE MI
48162-2904
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-7060
  • Fax: 734-241-7580
Mailing address:
  • Phone: 734-242-7060
  • Fax: 734-241-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT037750
License Number StateMI

VIII. Authorized Official

Name: MANHAR J TEJURA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-242-7060