Provider Demographics
NPI:1740473396
Name:CARDIOLOGY AND VASCULAR ASSOCIATES PC
Entity type:Organization
Organization Name:CARDIOLOGY AND VASCULAR ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALUIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-322-0083
Mailing Address - Street 1:42557 WOODWARD AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5206
Mailing Address - Country:US
Mailing Address - Phone:248-322-0083
Mailing Address - Fax:248-322-0084
Practice Address - Street 1:42557 WOODWARD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5206
Practice Address - Country:US
Practice Address - Phone:248-333-1170
Practice Address - Fax:248-333-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704192792363L00000X
MI4704167009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500F337710OtherBCBSM
MI500F337710OtherBCBSM