Advanced Cardiovascular Clinic PC
Organization Active NPI Clinic/Center · Flushing, MI
NPI 1104067487 · NPPES record last updated Sep 13, 2016
Key facts
- NPI
- 1104067487
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- ADVANCED CARDIOVASCULAR CLINIC PC
- Practice address
- 6122 W Pierson Rd
Unit 1
Flushing, MI 48433-3104 - Phone
- (810) 600-3399
- Fax
- (810) 600-3398
- NPI assigned
- Mar 16, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Mohammad Luay Alkotob, MD
- Title
- President
- Phone
- (810) 600-3399
Other NPIs with the same Medicare PAC ID 1
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Practitioners 12
-
Madar Abed, MD
-
Mohammad Luay Alkotob, MD, FACC, FSCAI
-
Erika Kristine Haddon, NP-C
-
Hassan M Ismail, MD
-
Imad Issawi, M.D.
-
Kristine Stamos, NP
-
Anwar Zaitoun, M.D.
-
Abdullah Haddad, M.D
-
Michelle Lynn Powell, NP-C
-
Hameem Changezi, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090526000039 | MI | Part B Supplier - Clinic/Group Practice | 7911056882 |
Receives reassigned benefits from 11 practitioners Practice locations: Flint, MI; Flushing, MI |
National Provider Directory
- Tax ID family
- Advanced Cardiovascular PC
Locations
5084 Villa Linde Pkwy
Flint, MI 48532
Phone (810) 733-6050
6122 W Pierson Rd
Flushing, MI 48433
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
6122 W Pierson Rd
Unit 1
Flushing, MI 48433-3104
Mailing address
6122 W Pierson Rd
Unit 1
Flushing, MI 48433-3104
Phone (810) 600-3399
Other providers in Flushing, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.