MEDICARE: CARDIOLOGY AND VASCULAR ASSOCIATES, PC

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	174400000X	Specialist	4301070779	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760482699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOLOGY AND VASCULAR ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	43344 WOODWARD AVE
Second Line	:	SUITE 111
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5049
Country	:	US
Telephone Number	:	248-333-1170
Fax Number	:	248-333-1175

Provider Business Practice Location Address
First Line	:	43344 WOODWARD AVE
Second Line	:	SUITE 111
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5049
Country	:	US
Telephone Number	:	248-333-1170
Fax Number	:	248-333-1175

Authorized Official
Title or Position	:	OWNER REPRESENTATIVE
Name	:	RAJENDRA PRASAD
Credential	:	CREDENTIALING
Telephone Number	:	248-844-1010

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/22/2020

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