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General NPI Number Information
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NPI Number | 1730440538
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Entity Type | Organization
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Legal Business Name | SOUTH MOUNTAIN CARDIOLOGY
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 303 E BASELINE RD #105
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City | PHOENIX
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State | AZ
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Zip | 85042-6530
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Country | US
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Telephone | 602-254-6640
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Fax | 602-254-6164
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Provider Business Mailing Address
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Address Line | 303 E BASELINE RD #105
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City | PHOENIX
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State | AZ
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Zip | 85042-6530
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Country | US
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Telephone | 602-254-6640
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Fax | 602-254-6164
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Authorized Official
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Title or Position | PROPRIETOR
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Name | NADEEM HUSAIN
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Credential | MD
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Telephone | 602-254-6640
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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 | 42751
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License Number State | AZ
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