=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306061205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AK HEART CENTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 E NORTHWOOD ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-574-2100
-----------------------------------------------------
Fax | 336-574-1260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 E NORTHWOOD ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-574-2100
-----------------------------------------------------
Fax | 336-574-1260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AJAY S KADAKIA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 336-574-2100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 79633
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------