=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003874983
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHIGAN INTERNAL MEDICINE AND CARDIOLOGY ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2006
-----------------------------------------------------
Last Update Date | 09/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2191 SOUTH BOULEVARD
-----------------------------------------------------
City | AUBURN HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-724-1420
-----------------------------------------------------
Fax | 248-724-1422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2191 SOUTH BLVD
-----------------------------------------------------
City | AUBURN HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48326-3479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-724-1420
-----------------------------------------------------
Fax | 248-724-1422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GHEORGHE N MARINESCU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 248-724-1420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | GM045944
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------