Provider Demographics
NPI:1043455058
Name:CARDIAC AND VASCULAR ASSOCIATION PC
Entity Type:Organization
Organization Name:CARDIAC AND VASCULAR ASSOCIATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:KIRITKUMAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-333-1170
Mailing Address - Street 1:645 BARCLAY CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5804
Mailing Address - Country:US
Mailing Address - Phone:248-844-1010
Mailing Address - Fax:248-844-8098
Practice Address - Street 1:43344 WOODWARD AVE
Practice Address - Street 2:STE. 111
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5049
Practice Address - Country:US
Practice Address - Phone:248-333-1170
Practice Address - Fax:248-333-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F38249OtherBCBSM
MIMI2203Medicare PIN