Provider Demographics
NPI:1588829345
Name:CARDIOVASCULAR CLINICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:CARDIOVASCULAR CLINICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASAK
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:248-615-7300
Mailing Address - Street 1:28080 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 300W
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5966
Mailing Address - Country:US
Mailing Address - Phone:248-615-7300
Mailing Address - Fax:248-615-7333
Practice Address - Street 1:23822 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3245
Practice Address - Country:US
Practice Address - Phone:313-359-0200
Practice Address - Fax:313-359-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty