Healthcare Provider Details

I. General information

NPI: 1275618027
Provider Name (Legal Business Name): MICHIGAN CARDIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 VENOY RD SUITE 200
WAYNE MI
48184-1869
US

IV. Provider business mailing address

4020 VENOY RD SUITE 200
WAYNE MI
48184-1869
US

V. Phone/Fax

Practice location:
  • Phone: 734-729-1900
  • Fax:
Mailing address:
  • Phone: 734-729-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberEG031436
License Number StateMI

VIII. Authorized Official

Name: CHANDRAKANT H PUJARA
Title or Position: OWNER
Credential: MD
Phone: 734-729-1900