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General NPI Number Information
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NPI Number | 1770501256
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Entity Type | Organization
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Legal Business Name | CARDIAC CARE CONSULTANTS, PC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 1730 45TH AVE
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City | MUNSTER
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State | IN
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Zip | 46321-3915
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Country | US
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Telephone | 219-836-9677
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Fax | 219-836-0688
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Provider Business Mailing Address
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Address Line | 1730 45TH AVE
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City | MUNSTER
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State | IN
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Zip | 46321-3915
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Country | US
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Telephone | 219-836-9677
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Fax | 219-836-0688
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | LOURDES CANELAS
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Credential |
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Telephone | 219-836-9677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 01042616
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 01040667
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License Number State | IN
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