Healthcare Provider Details

I. General information

NPI: 1235365123
Provider Name (Legal Business Name): HEART CLINICS PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E 89TH AVE SUITE 100
MERRILLVILLE IN
46410-8126
US

IV. Provider business mailing address

311 E 89TH AVE SUITE 100
MERRILLVILLE IN
46410-8126
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-8400
  • Fax: 219-756-8001
Mailing address:
  • Phone: 219-756-8400
  • Fax: 219-756-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01044106A
License Number StateIN

VIII. Authorized Official

Name: VIJAY P SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-756-8400