Healthcare Provider Details

I. General information

NPI: 1982772513
Provider Name (Legal Business Name): HEART CORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 6TH ST SW
CANTON OH
44710-1702
US

IV. Provider business mailing address

PO BOX 80600
CANTON OH
44708-0600
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-1342
  • Fax: 330-363-1361
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: AQEEL A SANDHU
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 330-363-1342