Provider Demographics
NPI:1699795435
Name:PREVENTIVE CARDIOVASCULAR INSTITUTE PLLC
Entity type:Organization
Organization Name:PREVENTIVE CARDIOVASCULAR INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIRAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-776-8877
Mailing Address - Street 1:25631 LITTLE MACK
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST. CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2108
Mailing Address - Country:US
Mailing Address - Phone:586-443-2930
Mailing Address - Fax:586-443-2958
Practice Address - Street 1:25631 LITTLE MACK
Practice Address - Street 2:SUITE 201
Practice Address - City:ST. CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2108
Practice Address - Country:US
Practice Address - Phone:586-443-2930
Practice Address - Fax:586-443-2958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E01170OtherBCBS OF MICHIGAN GRP NUMB