1114942000 NPI number — CARDIOLOGY ASSOCIATES OF MICHIGAN, P.C.

Table of content: (NPI 1114942000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114942000 NPI number — CARDIOLOGY ASSOCIATES OF MICHIGAN, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOLOGY ASSOCIATES OF MICHIGAN, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114942000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50505 SCHOENHERR RD
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
SHELBY TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48315-3140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-580-3062
Provider Business Mailing Address Fax Number:
586-580-3143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50505 SCHOENHERR RD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
SHELBY TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48315-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-580-3062
Provider Business Practice Location Address Fax Number:
586-580-3143
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRENNAN
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
586-580-3062

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G05065 . This is a "BLUE CARE NETWORK ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060E012720 . This is a "BLUE CROSS AND BLUE SHIEL" identifier . This identifiers is of the category "OTHER".




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