MEDICARE: HEART AND VASCULAR CARE, P.C.

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	207R00000X	Internal Medicine Physician
2	207RI0011X	Interventional Cardiology Physician
3	207RC0000X	Cardiovascular Disease Physician	JP071846	MI

General Provider Information

NPI Number	:	1689940397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART AND VASCULAR CARE, P.C.

Provider Business Mailing Address
First Line	:	6959 BRUNSWICK DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-1271
Country	:	US
Telephone Number	:	248-274-0169
Fax Number	:	480-275-3194

Provider Business Practice Location Address
First Line	:	4771 MICHIGAN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48210-3247
Country	:	US
Telephone Number	:	313-897-2140
Fax Number	:	313-897-2424

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. BABU S KONERU
Credential	:
Telephone Number	:	248-569-8989

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/30/2012

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