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General NPI Number Information
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NPI Number | 1265483978
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Entity Type | Organization
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Legal Business Name | THE HEART INSTITUTE PC
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2421 MONROE ST SUITE 101
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City | DEARBORN
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State | MI
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Zip | 48124-3043
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Country | US
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Telephone | 313-561-1520
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Fax | 313-561-1530
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Provider Business Mailing Address
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Address Line | 1844 MOMENTUM PL
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City | CHICAGO
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State | IL
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Zip | 60689-5318
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Country | US
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Telephone | 313-561-1520
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Fax | 313-561-1530
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Authorized Official
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Title or Position | MANAGING AGENT/OWNER
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Name | KALIL M MASRI
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Credential | DO
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Telephone | 313-561-1520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5101012443
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License Number State | MI
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