Healthcare Provider Details

I. General information

NPI: 1053684928
Provider Name (Legal Business Name): CARDIOVASCULAR CONSULTANTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 E PRINCESS DR SUITE 115
SCOTTSDALE AZ
85255-5483
US

IV. Provider business mailing address

PO BOX 98819
LAS VEGAS NV
89193-8819
US

V. Phone/Fax

Practice location:
  • Phone: 480-538-1355
  • Fax: 480-538-1356
Mailing address:
  • Phone: 602-494-3659
  • Fax: 602-795-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREI DAMIAN
Title or Position: MANAGING PARTNER / PRESIDENT
Credential: M.D.
Phone: 602-867-8644