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General NPI Number Information
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NPI Number | 1902631708
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CARDIOVASCULAR CARE CENTER
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 4300B W RAILROAD ST
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City | GULFPORT
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State | MS
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Zip | 39501-2568
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Country | US
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Telephone | 228-822-6722
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Fax |
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Provider Business Mailing Address
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Address Line | 4300B W RAILROAD ST
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City | GULFPORT
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State | MS
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Zip | 39501-2568
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Country | US
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Telephone | 228-822-6722
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Fax |
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Authorized Official
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Title or Position | MD/CO-OWNER
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Name | DR. SHWAN JALAL
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Credential | MD
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Telephone | 248-346-2174
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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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