Provider Demographics
NPI:1124127741
Name:ALLEN PARK CARDIOLOGY, P.C.
Entity type:Organization
Organization Name:ALLEN PARK CARDIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-928-2333
Mailing Address - Street 1:6742 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2034
Mailing Address - Country:US
Mailing Address - Phone:313-928-2333
Mailing Address - Fax:
Practice Address - Street 1:6742 PARK AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2034
Practice Address - Country:US
Practice Address - Phone:313-928-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI060H210310OtherBCBSMI
MIOM18000Medicare ID - Type Unspecified