Provider Demographics
NPI:1477002236
Name:BLOOMFIELD HEART CENTER PLLC
Entity Type:Organization
Organization Name:BLOOMFIELD HEART CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANTHINI
Authorized Official - Middle Name:
Authorized Official - Last Name:PALANICHAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-338-2420
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-338-2420
Mailing Address - Fax:248-858-3888
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-338-2420
Practice Address - Fax:248-858-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty