Provider Demographics
NPI:1609233113
Name:KAHN CENTER FOR CARDIAC LONGEVITY
Entity Type:Organization
Organization Name:KAHN CENTER FOR CARDIAC LONGEVITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-891-5068
Mailing Address - Street 1:4050 W MAPLE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3148
Mailing Address - Country:US
Mailing Address - Phone:248-731-7412
Mailing Address - Fax:
Practice Address - Street 1:4050 W MAPLE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48301-3148
Practice Address - Country:US
Practice Address - Phone:248-731-7412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047704207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty