Healthcare Provider Details

I. General information

NPI: 1356771661
Provider Name (Legal Business Name): LIFETIME CARDIOVASCULAR, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 E YEAGER DR
CHANDLER AZ
85286-1598
US

IV. Provider business mailing address

2487 S GILBERT RD STE 106-486
GILBERT AZ
85295-8899
US

V. Phone/Fax

Practice location:
  • Phone: 480-699-5536
  • Fax: 480-699-9283
Mailing address:
  • Phone: 480-699-5536
  • Fax: 480-699-9283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number44342
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GAUTAM KEDIA
Title or Position: OWNER/PHYSICIAN
Credential:
Phone: 480-699-5536