Healthcare Provider Details

I. General information

NPI: 1770780355
Provider Name (Legal Business Name): CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 MITCHELL DR STE 223
WALNUT CREEK CA
94598-1609
US

IV. Provider business mailing address

2855 MITCHELL DR STE 223
WALNUT CREEK CA
94598-1609
US

V. Phone/Fax

Practice location:
  • Phone: 925-975-5930
  • Fax: 925-975-5941
Mailing address:
  • Phone: 925-975-5930
  • Fax: 925-975-5941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL L LUDMER
Title or Position: PRESIDENT
Credential: MD
Phone: 510-452-1345