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General NPI Number Information
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NPI Number | 1154350890
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR INSTITUTE OF MICHIGAN, P.C.
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 18303 E 10 MILE RD SUITE 100
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City | ROSEVILLE
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State | MI
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Zip | 48066-4988
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Country | US
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Telephone | 586-776-8877
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Fax | 586-776-3092
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Provider Business Mailing Address
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Address Line | 18303 E 10 MILE RD SUITE 100
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City | ROSEVILLE
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State | MI
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Zip | 48066-4988
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Country | US
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Telephone | 586-776-8877
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Fax | 586-776-3092
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. MOHAMAD K AJJOUR
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Credential | M.D.
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Telephone | 586-776-8877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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