EASTSIDE CARDIOVASCULAR MEDICINE (NPI# 1811424245) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811424245 |
| Entity Type | Organization |
| Organization Name | EASTSIDE CARDIOVASCULAR MEDICINE |
| Practice Address |
25195 Kelly Rd Ste A Roseville MI 48066-4909 |
| Practice Telephone | 5867754594 |
| Practice Fax Number | 5867754506 |
| Mailing Telephone | 5867754594 |
| Mailing Fax Number | 5867754506 |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2017-05-16 |
| Authorized Official Name | DR. VAMSHIDHAR GUDUGUNTLA (DIRECTOR) |
| Authorized Official Telephone | 3134618684 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
4301094061 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
25195 KELLY RD STE A |
| City | ROSEVILLE |
| State | MI |
| Zip Code | 48066-4909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194729053 | Douglas R Moore | Internal Medicine | 25195 Kelly Rd Ste A, Roseville, MI 48066-4909 | 2005-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437761400 | Louay Mansour Dds PC | Dentist | 27845 Gratiot Avenue, Roseville, MI 48066 | 2020-08-20 |
| 1558911842 | Jomy Jose | Nurse Practitioner | 25719 Salem St, Roseville, MI 48066 | 2019-09-18 |
| 1053963033 | Convenient Rv PC | Dentist | 19551 E. 10 Mile Rd, Roseville, MI 48066 | 2019-07-10 |
| 1063914539 | Colleen Meriweather | Registered Nurse | 27300 Spruce, Rosevilel, MI 48066 | 2018-03-01 |
| 1326565789 | Renee Suzette Hoelzeman | Nurse Practitioner | 18472 Meier St, Roseville, MI 48066 | 2017-08-27 |
| 1225561400 | Eugenia Dillard | Counselor | 28351 Gratiot Ave., Suite 3, Roseville, MI 48066 | 2017-04-05 |
| 1932651338 | Julie Plichota | Physical Therapist | 31120 Gratiot Ave, Roseville, MI 48066 | 2016-11-01 |
| 1699221325 | Jaquenta Glasker | Technician, Other | 26778 Rosewood, Roseville, MI 48066 | 2016-09-01 |
| 1609296144 | Peter Jajou | Dermatology | 18285 E 10 Mile Rd Ste 130, Roseville, MI 48066 | 2014-04-23 |
| 1619393899 | Katherine Michelle Johnson | Obstetrics & Gynecology | 29751 Little Mack Ave Ste B, Roseville, MI 48066 | 2014-03-11 |
| Find all providers in zip 48066 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659889525 | Coordinated Health of Ca Iv, LLC | Internal Medicine | 1380 Lead Hill Blvd Ste 106c, Roseville, CA 95661-2997 | 2018-01-13 |
| 1376796938 | Harn-cherng Shiue | Internal Medicine | 1600 Eureka Rd, Roseville, CA 95661-3027 | 2008-10-28 |
| 1861493199 | Eastside Cardiovascular Medicine, P.C. | Internal Medicine | 25195 Kelly Road, Suite A, Roseville, MI 48066-4909 | 2005-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528606241 | Cypress Cardiology Pa | Internal Medicine | 1286 S Linden Rd Ste A, Flint, MI 48532-3457 | 2019-12-12 |
| 1609342757 | Michael Ira Klein | Internal Medicine | 111 Elm St Apt 331, Birmingham, MI 48009-6346 | 2018-10-16 |
| 1568954600 | Schreiber Cardiology, P.C. | Internal Medicine | 8545 Common Rd Ste 150, Warren, MI 48093 | 2018-06-05 |
| 1003319096 | Michigan Canton Cardiology Associates Pllc | Internal Medicine | 4020 Venoy Rd Ste 200, Wayne, MI 48184-1899 | 2018-03-15 |
| 1700337227 | Prime Vascular Center Pllc | Internal Medicine | G-5103 Miller Rd, Flint, MI 48507-1043 | 2016-10-19 |
| 1003366675 | K Heart & Vascular Institute, Pllc | Internal Medicine | 33376 Dequindre Road, Sterling Heights, MI 48310-5966 | 2016-10-07 |
| 1255738472 | Ashok Kondur Md PC | Internal Medicine | 4160 John R St Ste 525, Detroit, MI 48201-2022 | 2014-12-03 |
| 1952697252 | Abiy Temesgen Nigatu | Internal Medicine | 1000 E Paris Ave Se Ste 200, Grand Rapids, MI 49546 | 2011-06-24 |
| 1477845824 | Ehk Endovascular Pllc | Internal Medicine | 5500 Auto Club Drive, Suite 250, Dearborn, MI 48126-2683 | 2011-05-04 |
| 1134410970 | Erik Henry Howell | Internal Medicine | 14555 Levan Rd Ste 203, Livonia, MI 48154 | 2011-04-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.