Provider Demographics
NPI:1194893081
Name:CARDIOLOGY CONSULTANTS OF MICHIGAN & OHIO, P.C.
Entity type:Organization
Organization Name:CARDIOLOGY CONSULTANTS OF MICHIGAN & OHIO, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANHAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEJURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-242-7060
Mailing Address - Street 1:730 N MACOMB ST STE 429
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2904
Mailing Address - Country:US
Mailing Address - Phone:734-242-7060
Mailing Address - Fax:734-241-7580
Practice Address - Street 1:730 N MACOMB ST
Practice Address - Street 2:STE #429
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2900
Practice Address - Country:US
Practice Address - Phone:734-242-7060
Practice Address - Fax:734-241-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMT037750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102968533Medicaid
MI102968533Medicaid