Healthcare Provider Details

I. General information

NPI: 1538106711
Provider Name (Legal Business Name): CARDIOVASCULAR CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 DONALD POWERS DRIVE
MUNSTER IN
46321
US

IV. Provider business mailing address

10010 DONALD POWERS DRIVE
MUNSTER IN
46321
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-4200
  • Fax: 219-922-5904
Mailing address:
  • Phone: 219-934-4200
  • Fax: 219-922-5904

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: SHEILA SELMON
Title or Position: MANAGER
Credential:
Phone: 219-934-4200