Provider Demographics
NPI:1114942000
Name:CARDIOLOGY ASSOCIATES OF MICHIGAN, P.C.
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF MICHIGAN, P.C.
Other - Org Name:LAKEVIEW CARDIOLOGY, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:583-580-3062
Mailing Address - Street 1:50505 SCHOENHERR RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3140
Mailing Address - Country:US
Mailing Address - Phone:586-580-3062
Mailing Address - Fax:586-580-3143
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:SUITE 320
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-783-1111
Practice Address - Fax:586-783-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G05065OtherBLUE CARE NETWORK ID
060E012720OtherBLUE CROSS AND BLUE SHIEL
060E012720OtherBLUE CROSS AND BLUE SHIEL
=========OtherFEDERAL ID NUMBER