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General NPI Number Information
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NPI Number | 1679030530
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Entity Type | Organization
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Legal Business Name | HEART AND VASCULAR INSTITUTE
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 22720 MICHIGAN AVE STE 200
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City | DEARBORN
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State | MI
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Zip | 48124-2021
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Country | US
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Telephone | 313-791-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 22720 MICHIGAN AVE STE 200
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City | DEARBORN
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State | MI
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Zip | 48124-2021
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HANADY BEYDOUN
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Credential |
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Telephone | 313-993-7777
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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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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