Healthcare Provider Details

I. General information

NPI: 1669133260
Provider Name (Legal Business Name): EAU CLAIRE HEART INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/05/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 WEST HAMILTON AVE
EAU CLAIRE WI
54701-6925
US

IV. Provider business mailing address

659 WEST HAMILTON AVE
EAU CLAIRE WI
54701-6925
US

V. Phone/Fax

Practice location:
  • Phone: 715-831-4444
  • Fax: 920-526-5248
Mailing address:
  • Phone: 715-831-4444
  • Fax: 920-526-5248

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: ABD G. KHATIB
Title or Position: PRESIDENT
Credential:
Phone: 715-831-4444