Provider Demographics
NPI:1164972618
Name:AMIR KAKI MD PC
Entity Type:Organization
Organization Name:AMIR KAKI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-288-1117
Mailing Address - Street 1:1380 COOLIDGE HWY
Mailing Address - Street 2:250
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7069
Mailing Address - Country:US
Mailing Address - Phone:248-288-1117
Mailing Address - Fax:248-288-1107
Practice Address - Street 1:1380 COOLIDGE HWY
Practice Address - Street 2:250
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7069
Practice Address - Country:US
Practice Address - Phone:248-288-1117
Practice Address - Fax:248-288-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-08
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097701207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty