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General NPI Number Information
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NPI Number | 1245616929
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Entity Type | Organization
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Legal Business Name | VIRTUAL CARDIOLOGY, LLC
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 129 PHELPS AVE SUITE 406
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City | ROCKFORD
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State | IL
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Zip | 61108-2453
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Country | US
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Telephone | 815-397-5554
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Fax | 815-550-0061
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Provider Business Mailing Address
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Address Line | 129 PHELPS AVE SUITE 406
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City | ROCKFORD
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State | IL
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Zip | 61108-2453
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Country | US
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Telephone | 815-397-5554
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Fax | 815-550-0061
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Authorized Official
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Title or Position | CEO
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Name | MARTIN URBAN
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Credential | M.D.
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Telephone | 815-397-5554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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