EASTLAKE CARDIOVASCULAR PC (NPI# 1982657474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982657474 |
| Entity Type | Organization |
| Organization Name | EASTLAKE CARDIOVASCULAR PC |
| Practice Address |
24211 Little Mack Ave St Clair Shores MI 48080-1190 |
| Practice Telephone | 5864980440 |
| Practice Fax Number | 5864980401 |
| Mailing Telephone | 5864980440 |
| Mailing Fax Number | 5864980401 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2009-12-11 |
| Authorized Official Name | DR. GEORGE B GHANEM (PRESIDENT) |
| Authorized Official Telephone | 5864980440 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
MI | Allopathic & Osteopathic Physicians |
| Street Address |
24211 LITTLE MACK AVE |
| City | ST CLAIR SHORES |
| State | MI |
| Zip Code | 48080-1190 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104899269 | George B Ghanem | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-02-09 |
| 1699725606 | Georges B Ghafari | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-11 |
| 1124077953 | Joan S Crawford | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-09 |
| 1811946643 | William John Cushing | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-09 |
| 1497704191 | Thomas Alexander Lalonde | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-09 |
| 1902855166 | Vithal Kinhal | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-08 |
| 1952350126 | Brilio Conrado Mojares | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-08 |
| 1881643955 | Anthony J Kawa | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-08 |
| 1184673303 | Thomas Patrick Davis | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-06 |
| 1508814989 | Marc Oliver Gosselin | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508482084 | Farrah Aleema Rajab | Family Medicine | 24911 Little Mack Avenue, Suite C, St. Clair Shores, MI 48080 | 2020-06-22 |
| 1558986141 | Julia Anastazja Krakowska | Family Medicine | 24911 Little Mack, Suite C, St. Clair Shores, MI 48080 | 2020-06-10 |
| 1972073567 | Joyce Stepnak | Social Worker | 19611 E. 8 Mile Rd, Scs, MI 48080 | 2018-11-27 |
| 1487134177 | Bonnie Girson | Social Worker | 23409 Jefferson Ave Ste 100, Saint Clair Shores, MI 48080 | 2018-08-21 |
| 1609309913 | Park Pharmacy Scs LLC | Pharmacy | 20225 E 9 Mile Rd Ste 120a, Saint Clair Shores, MI 48080 | 2017-04-05 |
| 1730564055 | Mary Rose Giroux | Psychologist | 22516 Overlake St, St. Clair Shores, MI 48080 | 2015-07-28 |
| 1962882910 | Ali Tarif Bazzy | Family Medicine | 20225 E 9 Mile Rd Ste A, Saint Clair Shores, MI 48080 | 2015-06-04 |
| 1497156228 | Kelly Zalewski | Social Worker | 24631 Jefferson Ave, Saint Clair Shores, MI 48080 | 2014-09-11 |
| 1669871364 | Mallory Margret Gordon | Psychologist | 19900 E. 10 Mile Rd., Ste. 102, Saint Clair Shores, MI 48080 | 2014-08-19 |
| 1932549375 | Alexander Peter Bill | Otolaryngology | 22631 Greater Mack Ave Ste 200, Saint Clair Shores, MI 48080 | 2013-06-30 |
| Find all providers in zip 48080 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457300162 | Howard S Rosman | Internal Medicine | 24211 Little Mack, St Clair Shores, MI 48080-1151 | 2006-05-09 |
| 1104899269 | George B Ghanem | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-02-09 |
| 1699725606 | Georges B Ghafari | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-11 |
| 1124077953 | Joan S Crawford | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-09 |
| 1811946643 | William John Cushing | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-09 |
| 1497704191 | Thomas Alexander Lalonde | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-09 |
| 1902855166 | Vithal Kinhal | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-08 |
| 1952350126 | Brilio Conrado Mojares | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-08 |
| 1881643955 | Anthony J Kawa | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-08 |
| 1184673303 | Thomas Patrick Davis | Internal Medicine | 24211 Little Mack Ave, St Clair Shores, MI 48080-1190 | 2006-05-06 |
| Find all providers in ST CLAIR SHORES | ||||
| City | ST CLAIR SHORES |
| Zip Code | 48080 |
Please comment or provide details below to improve the information on EASTLAKE CARDIOVASCULAR PC.
| 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.