Healthcare Provider Details

I. General information

NPI: 1184185407
Provider Name (Legal Business Name): CMI CARE OF MI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W BIG BEAVER RD STE 2020
TROY MI
48084-4925
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 350
NASHVILLE TN
37205-2216
US

V. Phone/Fax

Practice location:
  • Phone: 615-386-0064
  • Fax:
Mailing address:
  • Phone: 615-386-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EDWARD LELAND HUTTON EADIE
Title or Position: DIRECTOR
Credential:
Phone: 615-733-2064