Healthcare Provider Details

I. General information

NPI: 1548224751
Provider Name (Legal Business Name): HEART CENTER OF LAKE COUNTY,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 BROADWAY
MERRILLVILLE IN
46410-2601
US

IV. Provider business mailing address

5800 BROADWAY SUITE A-J
MERRILLVILLE IN
46410-2601
US

V. Phone/Fax

Practice location:
  • Phone: 219-884-9180
  • Fax:
Mailing address:
  • Phone: 219-884-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDRE ARTIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-884-9180