# PREMIER VASCULAR CARE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639443773
- **Authorized official:** AJITH KADAKOL MD (PHYSICIAN / OWNER)
- **Authorized official phone:** (586) 573-8030

## Contact information

- **Practice address:** 1701 SOUTH BLVD E STE B75, ROCHESTER HILLS, MI 48307-6122
- **Practice address phone:** (248) 243-3935
- **Practice address fax:** (248) 284-7530
- **Mailing address:** 3205 LEGACY CT, W BLOOMFIELD, MI 48323-3634
- **Mailing address phone:** (583) 573-8030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 4301093222 | MI | Yes |

## Other

- **Enumeration date:** 03/07/2012
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1891742128 | INDV NPI | MI |
| 01 | — | 4301093222 | LICENSE | MI |
| 01 | — | 5315045037 | CONTROLLED SUBSTANCE LICENSE | MI |