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Organization

LIBERTY CARDIOLVASCULAR GROUP PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PRUDY A CASSEL (MANAGER)
(313) 724-9000
Entity
Organization

Contact information

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

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4715912
MI
Enumeration date
09/13/2017
Last updated
07/21/2022
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