Healthcare Provider Details

I. General information

NPI: 1205123387
Provider Name (Legal Business Name): COMPREHENSIVE CARDIOVASCULAR CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 S LINDBERGH BLVD SUITE 101
SAINT LOUIS MO
63127-1374
US

IV. Provider business mailing address

3760 S LINDBERGH BLVD SUITE 101
SAINT LOUIS MO
63127-1374
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-0923
  • Fax: 314-849-5716
Mailing address:
  • Phone: 314-849-0923
  • Fax: 314-849-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License NumberMDR4P45
License Number StateMO

VIII. Authorized Official

Name: DR. RAFFI KRIKORIAN
Title or Position: OWNER
Credential: MD
Phone: 314-849-0923