=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639644305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METROPOLITAN CARDIOVASCULAR CONSULTANTS & DIAGNOSTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2018
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28667 BAYBERRY CT E
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48154-3869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-331-2715
-----------------------------------------------------
Fax | 248-450-5580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 40202
-----------------------------------------------------
City | REDFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48240-0202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-331-2715
-----------------------------------------------------
Fax | 248-450-5580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAMANJIT KAUR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 313-333-8913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------