# LIBERTY CARDIOLVASCULAR GROUP PLLC

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

## Provider details

- **NPI number:** 1841719531
- **Authorized official:** PRUDY A CASSEL (MANAGER)
- **Authorized official phone:** (313) 724-9000

## Contact information

- **Practice address:** 5250 AUTO CLUB DR STE 300L, DEARBORN, MI 48126-2619
- **Practice address phone:** (313) 593-8988
- **Practice address fax:** (313) 982-1541
- **Mailing address:** 5250 AUTO CLUB DR STE 300L, DEARBORN, MI 48126-2619
- **Mailing address phone:** (313) 593-8988
- **Mailing address fax:** (313) 982-1541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 4301056091 | MI | Yes |

## Other

- **Enumeration date:** 09/13/2017
- **Last updated:** 07/21/2022