Healthcare Provider Details

I. General information

NPI: 1104139575
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES NORTHWEST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 RESEARCH BLVD SUITE 360
AUSTIN TX
78759-5264
US

IV. Provider business mailing address

11111 RESEARCH BLVD SUITE 360
AUSTIN TX
78759-5264
US

V. Phone/Fax

Practice location:
  • Phone: 512-617-1916
  • Fax: 512-617-1917
Mailing address:
  • Phone: 512-617-1916
  • Fax: 512-617-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: FOTINI M CHALKIAS
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 512-617-1916