Provider Demographics
NPI:1033281811
Name:ADVANCED HEART CARE
Entity Type:Organization
Organization Name:ADVANCED HEART CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PREM
Authorized Official - Middle Name:CHAND
Authorized Official - Last Name:GHAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-242-8880
Mailing Address - Street 1:1414 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-9228
Mailing Address - Country:US
Mailing Address - Phone:734-242-8880
Mailing Address - Fax:734-384-0139
Practice Address - Street 1:1414 STEWART RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-9228
Practice Address - Country:US
Practice Address - Phone:734-242-8880
Practice Address - Fax:734-384-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061054207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3292651Medicaid
D93260Medicare UPIN
MI3292651Medicaid