Healthcare Provider Details

I. General information

NPI: 1417128372
Provider Name (Legal Business Name): CARDIOLOGY DIAGNOSTICS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WEBER RD SUITE 105
FARMINGTON MO
63640-3326
US

IV. Provider business mailing address

2325 DOUGHERTY FERRY RD SUITE 205
SAINT LOUIS MO
63122-3356
US

V. Phone/Fax

Practice location:
  • Phone: 573-701-0222
  • Fax: 573-701-0220
Mailing address:
  • Phone: 314-966-9888
  • Fax: 314-966-5957

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. MARC K LEWEN
Title or Position: VICE PRESIDENT
Credential: D.O.
Phone: 314-966-9888