Healthcare Provider Details

I. General information

NPI: 1316155807
Provider Name (Legal Business Name): CARDIOLOGY CONSULTANTS OF EAST TEXAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 MULBERRY AVE SUITE 310
MT PLEASANT TX
75455-2312
US

IV. Provider business mailing address

2015 MULBERRY AVE SUITE 310
MT PLEASANT TX
75455-2312
US

V. Phone/Fax

Practice location:
  • Phone: 903-577-7070
  • Fax: 903-577-7072
Mailing address:
  • Phone: 903-577-7070
  • Fax: 903-577-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM2087
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04780
License Number StateTX

VIII. Authorized Official

Name: DR. MILAN SEKULIC
Title or Position: PRESIDENT
Credential: M.D.
Phone: 903-577-7070