MEDICARE: ARIZONA HEART SPECIALISTS PLLC

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1750513438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA HEART SPECIALISTS PLLC

Provider Business Mailing Address
First Line	:	10503 W THUNDERBIRD BLVD
Second Line	:	STE 103
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3022
Country	:	US
Telephone Number	:	623-974-3649
Fax Number	:	623-974-8364

Provider Business Practice Location Address
First Line	:	316 W WHITE MOUNTAIN BLVD
Second Line	:	STE B
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-7015
Country	:	US
Telephone Number	:	928-367-9958
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	KUMAR L RAVI
Credential	:	MD
Telephone Number	:	623-974-3649

Provider Enumeration Date	:	08/14/2009
Last Update Date	:	01/23/2012

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