Organization
EASTSIDE CARDIOVASCULAR MEDICINE, P.C.
Active
Other names
Eastside Cardiology PC
Organization subpart
No
Provider details
NPI number
Authorized official
VAMSHIDHAR D GUDUGUNTIA M.D. (PRESIDENT/EASTSIDE CARDIOVASCULAR M)
(586) 775-4594
Entity
Organization
Contact information
Practice address
25195 KELLY ROAD, SUITE A, ROSEVILLE, MI 48066-4909
(586) 775-4594
(586) 775-4506
Mailing address
25195 KELLY RD, SUITE A, ROSEVILLE, MI 48066-4909
(586) 775-4594
(586) 775-4506
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060E01111
BLUE CROSS BLUE SHIELD
MI
Enumeration date
08/09/2005
Last updated
07/21/2022
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