Healthcare Provider Details

I. General information

NPI: 1437335494
Provider Name (Legal Business Name): INDIANA HEART AND VASCULAR INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E COOLSPRING AVE SUITE 400
MICHIGAN CITY IN
46360-6312
US

IV. Provider business mailing address

1225 E COOLSPRING AVE SUITE 400
MICHIGAN CITY IN
46360-6312
US

V. Phone/Fax

Practice location:
  • Phone: 219-861-8170
  • Fax: 219-871-7520
Mailing address:
  • Phone: 219-861-8170
  • Fax: 219-871-7520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01041339A
License Number StateIN

VIII. Authorized Official

Name: WILLIAM G ESPAR
Title or Position: PRESIDENT
Credential: MD
Phone: 219-874-1400