Provider Demographics
NPI:1144643149
Name:HEART AND VASCULAR SPECIALISTS PC
Entity type:Organization
Organization Name:HEART AND VASCULAR SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAZRAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:248-250-9474
Mailing Address - Street 1:2221 LIVERNOIS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1603
Mailing Address - Country:US
Mailing Address - Phone:248-250-9474
Mailing Address - Fax:248-250-9483
Practice Address - Street 1:2221 LIVERNOIS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1603
Practice Address - Country:US
Practice Address - Phone:248-250-9474
Practice Address - Fax:248-250-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084367207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty