Provider Demographics
NPI:1003366675
Name:K HEART & VASCULAR INSTITUTE, PLLC
Entity Type:Organization
Organization Name:K HEART & VASCULAR INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KONERU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-722-7440
Mailing Address - Street 1:33376 DEQUINDRE ROAD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5966
Mailing Address - Country:US
Mailing Address - Phone:586-722-7440
Mailing Address - Fax:586-722-7675
Practice Address - Street 1:33376 DEQUINDRE ROAD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5966
Practice Address - Country:US
Practice Address - Phone:586-722-7440
Practice Address - Fax:586-722-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0501427OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0E05972OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI1477599587Medicaid
MI0501427OtherBLUE CROSS BLUE SHIELD OF MICHIGAN