Healthcare Provider Details

I. General information

NPI: 1982875779
Provider Name (Legal Business Name): ASSOCIATES IN CARDIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 GREENFIELD RD SUITE 231
SOUTHFIELD MI
48075-3710
US

IV. Provider business mailing address

22255 GREENFIELD RD SUITE 231
SOUTHFIELD MI
48075-3710
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-0122
  • Fax:
Mailing address:
  • Phone: 248-569-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number32141
License Number StateMI

VIII. Authorized Official

Name: CAROLYN JEAN HOLLAND
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-569-0122