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General NPI Number Information
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NPI Number | 1629177076
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Entity Type | Organization
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Legal Business Name | INDIANA CARDIAC & VASCULAR CONSULTANTS
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 1101 W JEFFERSON ST SUITE J
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City | FRANKLIN
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State | IN
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Zip | 46131-2147
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Country | US
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Telephone | 317-736-8383
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Fax | 317-736-0790
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Provider Business Mailing Address
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Address Line | 1101 W JEFFERSON ST SUITE J
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City | FRANKLIN
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State | IN
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Zip | 46131-2147
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Country | US
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Telephone | 317-736-8383
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Fax | 317-736-0790
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Authorized Official
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Title or Position | CEO
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Name | HABIB JOHN KOMARI
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Credential | MD
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Telephone | 317-887-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01040158A
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License Number State | IN
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