MEDICARE: INDIANA CARDIAC & VASCULAR CONSULTANTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134154255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA CARDIAC & VASCULAR CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	1350 E COUNTY LINE RD
Second Line	:	SUITE H
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0873
Country	:	US
Telephone Number	:	317-887-7700
Fax Number	:	317-887-7728

Provider Business Practice Location Address
First Line	:	1350 E COUNTY LINE RD
Second Line	:	SUITE H
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0873
Country	:	US
Telephone Number	:	317-887-7700
Fax Number	:	317-887-7728

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	HABIB JOHN KOMARI
Credential	:	MD
Telephone Number	:	317-887-7700

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/25/2008

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