PREMIER VASCULAR CARE PC (NPI# 1639443773) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639443773 |
| Entity Type | Organization |
| Organization Name | PREMIER VASCULAR CARE PC |
| Practice Address |
1701 South Blvd E Ste B75 Rochester Hills MI 48307-6122 |
| Mailing Address |
3205 Legacy Ct W Bloomfield MI 48323-3634 |
| Practice Telephone | 2482433935 |
| Practice Fax Number | 2482847530 |
| Mailing Telephone | 5835738030 |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2018-06-20 |
| Authorized Official Name | AJITH KADAKOL (PHYSICIAN / OWNER) |
| Authorized Official Telephone | 5865738030 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
4301093222 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | DEA | FK2029331 | 01 |
| MI | CONTROLLED SUBSTANCE LICENSE | 5315045037 | 01 |
| MI | LICENSE | 4301093222 | 01 |
| MI | INDV NPI | 1891742128 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 43211 Dalcoma Dr, North Wing Suite B, Clinton Twp, MI 480386309 | 5865738030 |
| Street Address |
1701 SOUTH BLVD E STE B75 |
| City | ROCHESTER HILLS |
| State | MI |
| Zip Code | 48307-6122 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891742128 | Ajith K Kadakol | Surgery | 1701 South Blvd E Ste B75, Rochester Hills, MI 48307-6122 | 2006-05-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083238851 | Martin Dukaj | Student in an Organized Health Care Education/Training Program | 1101 Walton Blvd, Rochester Hills, MI 48307 | 2020-06-08 |
| 1073151973 | Cynthia Lynn Olekszyk | Dietitian, Registered | 645 Barclay Circle, Rochester Hills, MI 48307 | 2019-12-11 |
| 1326502428 | Jessica Delia | Nurse Practitioner | 1701 E South Boulevard, Suite 290, Rochester Hills, MI 48307 | 2019-01-23 |
| 1528530037 | Kelie Friday | Physical Therapist | 312 Rochester Hills, Dearborn, MI 48307 | 2018-12-21 |
| 1538635883 | Julie Latarewicz | Physical Therapist | Ascension Providence Rochester Hospital, 1101 West University Drive, Rochester, MI 48307 | 2018-10-15 |
| 1891270757 | Leah Marx | Social Worker | 3950 Rochester Rd, Ste 2250, Rochester Hills, MI 48307 | 2018-09-26 |
| 1598256729 | Frederick Alan Bittner | Student in an Organized Health Care Education/Training Program | 1101 W. University Drive, 3 North, Rochester, MI 48307 | 2018-05-23 |
| 1508356346 | Ankita Aggarwal | Student in an Organized Health Care Education/Training Program | Wsu/ascension Crittenton Hospital, 1101 W. University Drive, Rochester, MI 48307 | 2018-05-17 |
| 1619478195 | Michelle Nuccio | Occupational Therapist | 1555 E South Blvd, Rochester Hills, MI 48307 | 2018-02-21 |
| 1265932024 | Stacy Dietlin Linn | Physical Therapist | 1555 E. South Blvd, Suite 120, Rochester Hills, MI 48307 | 2018-02-19 |
| Find all providers in zip 48307 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437660057 | Iha Health Services Corporation | Surgery | 5333 Mcauley Dr Rm 4016, Ypsilanti, MI 48197-1001 | 2017-10-23 |
| 1760900138 | Integrated Vascular Vein Center of Michigan PC | Surgery | 600 Health Park Blvd Ste G, Grand Blanc, MI 48439-2558 | 2017-09-06 |
| 1770036147 | Joseph P. Elliott Jr. | Surgery | 3282 Woodview Lake Rd, West Bloomfield, MI 48323-3570 | 2016-08-02 |
| 1043676661 | Integrative Cardiovascular Health & Wellness | Surgery | 3250 Woods Way, Suite 9, Petoskey, MI 49770-7628 | 2016-01-12 |
| 1124411244 | Vascular Surgery Assoc, PC | Surgery | 1122 S Lapeer Rd Ste C, Lapeer, MI 48446-3387 | 2015-03-13 |
| 1013309988 | Bloomfield Vein & Vascular Pllc | Surgery | 43700 Woodward Ave Ste 207, Bloomfield Hills, MI 48302-5061 | 2015-03-02 |
| 1114288206 | Scott Bendix | Surgery | 28100 Grand River Ave Ste 200, Farmington Hills, MI 48336-5969 | 2012-06-05 |
| 1942561428 | Charles J Shanley Md PC | Surgery | 1001 Audubon Rd, Grosse Pointe, MI 48230-1406 | 2012-05-31 |
| 1508122995 | Robert J Cardwell Md Pllc | Surgery | 13312 Terry Dr, Shelby Township, MI 48315-5365 | 2012-04-10 |
| 1780919936 | Martin A V Tuma Md Vascular Surgery Pllc | Surgery | 22255 Greemfield Road #250, Southfield, MI 48075 | 2009-10-06 |
| Find all providers with the same taxonomy | ||||
| City | ROCHESTER HILLS |
| Zip Code | 48307 |
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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.