Healthcare Provider Details

I. General information

NPI: 1780919886
Provider Name (Legal Business Name): HEART CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7806 W JEFFERSON BLVD SUITE D
FORT WAYNE IN
46804-4180
US

IV. Provider business mailing address

7806 W JEFFERSON BLVD SUITE D
FORT WAYNE IN
46804-4180
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-7000
  • Fax: 260-969-9119
Mailing address:
  • Phone: 260-432-7000
  • Fax: 260-969-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SUBHASH K. REDDY
Title or Position: OWNER
Credential: MD
Phone: 260-432-7000