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General NPI Number Information
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NPI Number | 1659438513
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Entity Type | Organization
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Legal Business Name | BAY AREA CARDIOVASCULAR MEDICAL GROUP
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 39300 CIVIC CENTER DR #140
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City | FREMONT
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State | CA
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Zip | 94538-2338
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Country | US
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Telephone | 510-791-1005
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Fax | 510-791-2874
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Provider Business Mailing Address
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Address Line | 39300 CIVIC CENTER DR #140
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City | FREMONT
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State | CA
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Zip | 94538-2338
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Country | US
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Telephone | 510-791-1005
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Fax | 510-791-2874
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN THOMAS MEHIGAN
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Credential | M.D.
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Telephone | 510-791-1005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | G16196
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License Number State | CA
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