Healthcare Provider Details

I. General information

NPI: 1699027763
Provider Name (Legal Business Name): CONCIERGE CARDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 LINCOLNWAY LOFT #2
LA PORTE IN
46350-3411
US

IV. Provider business mailing address

1608 LINCOLNWAY SUITE G
VALPARAISO IN
46383-5856
US

V. Phone/Fax

Practice location:
  • Phone: 219-380-5724
  • Fax: 219-575-7345
Mailing address:
  • Phone: 219-476-0352
  • Fax: 219-531-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number02001043A
License Number StateIN

VIII. Authorized Official

Name: JOSEPH ROSENBLUM
Title or Position: CEO
Credential: DO
Phone: 219-929-7900