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General NPI Number Information
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NPI Number | 1366577827
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Entity Type | Organization
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Legal Business Name | CARDIAC CARE CONSULTANTS OF NM, PC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 4824 MCMAHON BLVD, NW #115
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City | ALBUQUERQUE
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State | NM
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Zip | 87114
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Country | US
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Telephone | 505-248-1800
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Fax | 505-248-1917
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Provider Business Mailing Address
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Address Line | 4824 MCMAHON BLVD, NW #115
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City | ALBUQUERQUE
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State | NM
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Zip | 87114
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Country | US
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Telephone | 505-248-1800
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Fax | 505-248-1917
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL E. GURULE
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Credential | MD
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Telephone | 505-248-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | PT0018282
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License Number State | NM
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