Provider Demographics
NPI:1053970624
Name:JACKSON CARDIOLOGY CONSULTANTS PLLC
Entity type:Organization
Organization Name:JACKSON CARDIOLOGY CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAREQ
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-787-3577
Mailing Address - Street 1:PO BOX 772603
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2603
Mailing Address - Country:US
Mailing Address - Phone:517-787-4414
Mailing Address - Fax:517-926-8926
Practice Address - Street 1:205 PAGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2462
Practice Address - Country:US
Practice Address - Phone:517-787-3577
Practice Address - Fax:517-787-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty