Provider Demographics
NPI:1003166075
Name:HEART & VASCULAR INSTITUTE OF MI P.C.
Entity type:Organization
Organization Name:HEART & VASCULAR INSTITUTE OF MI P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAJED
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUNOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-667-7333
Mailing Address - Street 1:1075 SUNCREST DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-4403
Mailing Address - Country:US
Mailing Address - Phone:810-667-7333
Mailing Address - Fax:810-660-8133
Practice Address - Street 1:1075 SUNCREST DR
Practice Address - Street 2:SUITE C
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4403
Practice Address - Country:US
Practice Address - Phone:810-667-7333
Practice Address - Fax:810-660-8133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091738207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003166075Medicaid