Provider Demographics
NPI:1003880410
Name:MAPLE CARDIOLOGY & INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:MAPLE CARDIOLOGY & INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBOTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-737-0091
Mailing Address - Street 1:5799 W MAPLE RD
Mailing Address - Street 2:SUITE 159
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4458
Mailing Address - Country:US
Mailing Address - Phone:248-737-0091
Mailing Address - Fax:248-737-0095
Practice Address - Street 1:5799 W MAPLE RD
Practice Address - Street 2:SUITE 159
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4458
Practice Address - Country:US
Practice Address - Phone:248-737-0091
Practice Address - Fax:248-737-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005981207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4274890Medicaid
MION21450Medicare ID - Type Unspecified
MI4274890Medicaid