MEDICARE: DEARBORN HEART & VASCULAR ASSOCIATES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1295691988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEARBORN HEART & VASCULAR ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	15120 MICHIGAN AVE STE B
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3768
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15120 MICHIGAN AVE STE B
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3768
Country	:	US
Telephone Number	:	313-300-5707
Fax Number	:

Authorized Official
Title or Position	:	INTERVENTIONAL CARDIOLOGIST
Name	:	KAMAL MOHAMED-AYED KASSEM
Credential	:	MD
Telephone Number	:	313-300-5707

Provider Enumeration Date	:	12/27/2025
Last Update Date	:	12/27/2025

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