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General NPI Number Information
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NPI Number | 1639569171
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR CONSULTANTS OF MARION PC
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 1123 N WESTERN AVE
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City | MARION
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State | IN
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Zip | 46952-2501
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Country | US
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Telephone | 765-651-9347
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Fax | 765-651-9346
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Provider Business Mailing Address
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Address Line | 1123 N WESTERN AVE
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City | MARION
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State | IN
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Zip | 46952-2501
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Country | US
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Telephone | 765-651-9347
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Fax | 765-651-9346
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Authorized Official
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Title or Position | OWNER
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Name | GARY ALLEN FRICK
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Credential | DO
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Telephone | 765-651-9347
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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 | 02001087A
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License Number State | IN
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