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NPI Code Detail

MEDICARE: CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC.

MEDICARE: CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC.
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
1207RC0000XCardiovascular Disease Physician
2207RC0001XClinical Cardiac Electrophysiology Physician
3207RI0011XInterventional Cardiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ56225ZOTHERCABLUE SHIELD PROVIDER NUMBER

General Provider Information

NPI Number : 1710922034
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 2855 MITCHELL DR
Second Line : #223
City : WALNUT CREEK
State : CA
Zip : 94598-1600
Country : US
Telephone Number : 925-277-1900
Fax Number : 925-277-1568
Provider Business Practice Location Address
First Line : 5201 NORRIS CANYON RD
Second Line : #220
City : SAN RAMON
State : CA
Zip : 94583-5411
Country : US
Telephone Number : 925-277-1900
Fax Number : 925-277-1568
Authorized Official
Title or Position : PRESIDENT
Name : PAUL L LUDMER
Credential : MD
Telephone Number : 510-452-1345
Provider Enumeration Date : 06/19/2006
Last Update Date : 06/25/2010

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