Basic Information
| Provider Information | |||||||||
| NPI: | 1285670299 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOLOGY CONSULTANTS OF EAST MICHIGAN PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 S LINDEN RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485325475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107330790 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2222 S LINDEN RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485325475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107330790 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 11/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | BRILL | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8106644870 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 060B514420 | 01 | MI | BCBS OF MI GROUP PIN | OTHER |