Provider Demographics
NPI:1477845824
Name:EHK ENDOVASCULAR PLLC
Entity Type:Organization
Organization Name:EHK ENDOVASCULAR PLLC
Other - Org Name:MICHIGAN OUTPATIENT VASCULAR INSTITUTE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:KASSAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-359-8300
Mailing Address - Street 1:5250 AUTO CLUB DR STE 170
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2619
Mailing Address - Country:US
Mailing Address - Phone:313-359-8300
Mailing Address - Fax:313-359-8036
Practice Address - Street 1:5250 AUTO CLUB DR STE 170
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2619
Practice Address - Country:US
Practice Address - Phone:313-359-8300
Practice Address - Fax:313-359-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047006207RC0000X, 207RI0011X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H27482OtherBCN GROUP PIN
MI0H27482OtherBCBS GROUP PIN
MIDT5132OtherRAILROAD MEDICARE GP PTAN
MIDT5132OtherRAILROAD MEDICARE GP PTAN
MIDT5132OtherRAILROAD MEDICARE GP PTAN