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General NPI Number Information
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NPI Number | 1679623334
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY CONSULTANTS PC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5848 EXECUTIVE DR
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City | LANSING
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State | MI
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Zip | 48911
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Country | US
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Telephone | 517-882-8222
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Fax | 517-882-5345
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Provider Business Mailing Address
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Address Line | 5848 EXECUTIVE DR
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City | LANSING
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State | MI
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Zip | 48911
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Country | US
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Telephone | 517-882-8222
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Fax | 517-882-5345
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. JWALA PRASAO
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Credential | MD
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Telephone | 517-882-8222
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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 |
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License Number State |
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