Healthcare Provider Details

I. General information

NPI: 1538494265
Provider Name (Legal Business Name): ENVER LLANA RCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 SHERWOOD AVE
WARREN MI
48091-4154
US

IV. Provider business mailing address

28839 FLORAL ST
ROSEVILLE MI
48066-7420
US

V. Phone/Fax

Practice location:
  • Phone: 586-757-3300
  • Fax: 586-757-3301
Mailing address:
  • Phone: 586-757-3300
  • Fax: 586-757-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number00074367
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: