MEDICARE: KAHN CENTER FOR CARDIAC LONGEVITY

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	4301047704	MI

General Provider Information

NPI Number	:	1609233113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAHN CENTER FOR CARDIAC LONGEVITY

Provider Business Mailing Address
First Line	:	4050 W MAPLE RD
Second Line	:	SUITE 108
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48301-3148
Country	:	US
Telephone Number	:	248-731-7412
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 W MAPLE RD
Second Line	:	SUITE 108
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48301-3148
Country	:	US
Telephone Number	:	248-731-7412
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOEL K KAHN
Credential	:	M.D.
Telephone Number	:	248-891-5068

Provider Enumeration Date	:	01/28/2016
Last Update Date	:	01/28/2016

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