Healthcare Provider Details

I. General information

NPI: 1083857056
Provider Name (Legal Business Name): ALKEYLANI CARDIOLOGY AND FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BOULDER LN
MANSFIELD CTR CT
06250-1105
US

IV. Provider business mailing address

3 BOULDER LN
MANSFIELD CTR CT
06250-1105
US

V. Phone/Fax

Practice location:
  • Phone: 860-429-2077
  • Fax: 860-429-2077
Mailing address:
  • Phone: 860-429-2077
  • Fax: 860-429-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number035596
License Number StateCT

VIII. Authorized Official

Name: ABD U ALKEYLANI
Title or Position: OWNER
Credential: MD
Phone: 860-129-2077