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General NPI Number Information
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NPI Number | 1730572611
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Entity Type | Organization
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Legal Business Name | CARDIOMETABOLIC CLINIC & RESEARCH CENTER
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 11620 MEDALLION LN
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City | AUSTIN
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State | TX
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Zip | 78750-2630
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Country | US
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Telephone | 512-297-2611
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Fax |
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Provider Business Mailing Address
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Address Line | 115 SUNDANCE PKWY SUITE 424
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City | ROUND ROCK
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State | TX
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Zip | 78681-7914
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Country | US
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Telephone | 512-568-6635
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Fax | 509-694-1312
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. VASUDEVAN A RAGHAVAN
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Credential | MBBS, MD, MRCP(UK)
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Telephone | 512-568-6635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | M2490
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License Number State | TX
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