Healthcare Provider Details

I. General information

NPI: 1639232036
Provider Name (Legal Business Name): CARDIOVASCULAR CONSULTING ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S LAKE PARK AVE STE 400
HOBART IN
46342-6636
US

IV. Provider business mailing address

1400 S LAKE PARK AVE STE 400
HOBART IN
46342-6636
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-6166
  • Fax: 219-942-4106
Mailing address:
  • Phone: 219-942-6166
  • Fax: 219-942-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. JACK H ZIEGLER
Title or Position: OWNER-MD
Credential: MD
Phone: 219-942-6166