Healthcare Provider Details

I. General information

NPI: 1316003742
Provider Name (Legal Business Name): CARDIOVASCULAR CLINICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 86TH PL
MERRILLVILLE IN
46410-6258
US

IV. Provider business mailing address

200 E 86TH PL
MERRILLVILLE IN
46410-6258
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-1400
  • Fax: 219-756-1413
Mailing address:
  • Phone: 219-756-1400
  • Fax: 219-756-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number50004087A
License Number StateIN

VIII. Authorized Official

Name: DR. HARISH SHAH
Title or Position: PARTNER
Credential: M.D.
Phone: 219-756-1400