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General NPI Number Information
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NPI Number | 1417395039
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Entity Type | Organization
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Legal Business Name | MOST SACRED HEART OF JESUS CARDIOLOGY AND VALVULAR INSTITUTE
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 703 N 8TH ST SUITE 303
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City | SHEBOYGAN
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State | WI
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Zip | 53081-4501
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Country | US
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Telephone | 920-451-4611
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Fax | 855-827-3381
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Provider Business Mailing Address
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Address Line | 703 N 8TH ST SUITE 303
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City | SHEBOYGAN
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State | WI
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Zip | 53081-4501
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Country | US
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Telephone | 920-451-4611
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Fax | 855-827-3381
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Authorized Official
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Title or Position | PRESIDENT
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Name | NALINI M RAJAMANNAN
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Credential | M.D.
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Telephone | 920-451-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 41806
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License Number State | WI
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