Healthcare Provider Details

I. General information

NPI: 1720651862
Provider Name (Legal Business Name): QUEEN OF HEARTS CARDIOVASCULAR & FAMILY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8684 CONNECTICUT ST STE A
MERRILLVILLE IN
46410-5581
US

IV. Provider business mailing address

8684 CONNECTICUT ST STE A
MERRILLVILLE IN
46410-5581
US

V. Phone/Fax

Practice location:
  • Phone: 219-472-8990
  • Fax: 219-472-0270
Mailing address:
  • Phone: 219-472-8990
  • Fax: 219-472-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEPHANIE D MARSHALL
Title or Position: OWNER
Credential: DO
Phone: 192-472-8990