Provider Demographics
NPI:1265483978
Name:THE HEART INSTITUTE PC
Entity Type:Organization
Organization Name:THE HEART INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING AGENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-561-1520
Mailing Address - Street 1:1844 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5318
Mailing Address - Country:US
Mailing Address - Phone:313-561-1520
Mailing Address - Fax:313-561-1530
Practice Address - Street 1:2421 MONROE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3043
Practice Address - Country:US
Practice Address - Phone:313-561-1520
Practice Address - Fax:313-561-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012443207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N90720Medicare ID - Type Unspecified