Organization
PROVIDENCE CARDIOLOGY SERVICES I
Active
Organization
PROVIDENCE CARDIOLOGY SERVICES I
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISSAC GRINBERG M.D. (PRESIDENT)
(248) 552-9858
Entity
Organization
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 552-9858
(248) 552-9510
Mailing address
22250 PROVIDENCE DR, SUITE 705, SOUTHFIELD, MI 48075-4825
(248) 552-9858
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
MI
2085R0202X
Diagnostic Radiology Physician
—
MI
Other
Enumeration date
02/07/2006
Last updated
04/19/2012
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