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General NPI Number Information
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NPI Number | 1427276773
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Entity Type | Organization
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Legal Business Name | ALLEN COUNTY CARDIOLOGY LLC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 604 W. BERRY ST
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City | FT WAYNE
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State | IN
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Zip | 46802-2106
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Country | US
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Telephone | 260-423-1331
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Fax | 260-422-1046
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Provider Business Mailing Address
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Address Line | 604 W. BERRY ST
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City | FT WAYNE
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State | IN
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Zip | 46802-2106
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Country | US
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Telephone | 260-423-1331
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Fax | 260-422-1046
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Authorized Official
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Title or Position | MANG. PARTNER
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Name | NAVEEN LAL
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Credential | MD
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Telephone | 260-423-1331
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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 | 01045695A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01027373A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 01051517A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01050563A
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License Number State | IN
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