Provider Demographics
NPI:1679030530
Name:HEART AND VASCULAR INSTITUTE
Entity type:Organization
Organization Name:HEART AND VASCULAR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HANADY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-993-7777
Mailing Address - Street 1:22720 MICHIGAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22720 MICHIGAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2021
Practice Address - Country:US
Practice Address - Phone:313-791-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALO MEDICAL GROUP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1144341645Medicaid
11615581OtherCAQH
11892261OtherCAQH
12440670OtherCAQH
MI1881916435Medicaid
MI1932149838Medicaid
12063174OtherCAQH
12345659OtherCAQH
MI1912263914Medicaid
12151256OtherCAQH
MI1417010315Medicaid
MI1326291428Medicaid
MI1962427260Medicaid
12091363OtherCAQH
12248863OtherCAQH
12718965OtherCAQH
MI1457687584Medicaid
MI1043473382Medicaid
14396095OtherCAQH
MI1831154798Medicaid