Provider Demographics
NPI:1003319096
Name:MICHIGAN CANTON CARDIOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MICHIGAN CANTON CARDIOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GULATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-326-0740
Mailing Address - Street 1:1212 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFLD HLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1955
Mailing Address - Country:US
Mailing Address - Phone:734-729-6710
Mailing Address - Fax:734-729-6715
Practice Address - Street 1:2050 N HAGGERTY RD STE B2
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3795
Practice Address - Country:US
Practice Address - Phone:734-326-0740
Practice Address - Fax:734-326-0785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301035830Medicaid