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General NPI Number Information
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NPI Number | 1790231926
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Entity Type | Organization
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Legal Business Name | PERRY COUNTY CARDIOLOGY LLC
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 09/30/2016
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Provider Practice Location Address
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Address Line | 8735 STATE ROAD 37 SUITE B
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City | TELL CITY
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State | IN
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Zip | 47586-8349
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Country | US
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Telephone | 812-772-2040
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Fax | 812-772-2042
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Provider Business Mailing Address
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Address Line | 8735 STATE ROAD 37 SUITE B
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City | TELL CITY
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State | IN
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Zip | 47586-8349
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Country | US
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Telephone | 812-772-2040
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Fax | 812-772-2042
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MUKESH GUPTA
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Credential | MD
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Telephone | 812-772-2040
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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 | 01048460
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License Number State | IN
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