Provider Demographics
NPI:1154392132
Name:CARDIOVASCULAR CLINICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:CARDIOVASCULAR CLINICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-615-7315
Mailing Address - Street 1:17880 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3104
Mailing Address - Country:US
Mailing Address - Phone:248-615-7300
Mailing Address - Fax:248-615-7333
Practice Address - Street 1:17880 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3104
Practice Address - Country:US
Practice Address - Phone:248-615-7300
Practice Address - Fax:248-615-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0F37150Medicare PIN