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NPI Code Detail

MEDICARE: PEDIATRIC CARDIOLOGY, P.C.

MEDICARE: PEDIATRIC CARDIOLOGY, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080P0202XPediatric Cardiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083696793
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC CARDIOLOGY, P.C.
Provider Business Mailing Address
First Line : 330 LAUREL ST
Second Line : SUITE 2200
City : DES MOINES
State : IA
Zip : 50314-3034
Country : US
Telephone Number : 515-288-1097
Fax Number : 515-288-2847
Provider Business Practice Location Address
First Line : 330 LAUREL ST
Second Line : SUITE 2200
City : DES MOINES
State : IA
Zip : 50314-3034
Country : US
Telephone Number : 515-288-1097
Fax Number : 515-288-2847
Authorized Official
Title or Position : PRESIDENT
Name : DR. BASAVIAH CHANDRAMOULI
Credential : M.D.
Telephone Number : 515-288-1097
Provider Enumeration Date : 11/17/2005
Last Update Date : 08/22/2020

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Practice Location Address:
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1235137340 — MOHAMMAD S IQBAL MD
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1477535185 — DR. THOMAS EDWARD BECKER M.D.
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330 LAUREL ST , SUITE 2200
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1023090735 — DR. BASAVIAH CHANDRAMOULI M.D.
Practice Location Address:
330 LAUREL ST , SUITE 2200
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1902888613 — DR. STEPHEN JAMES MOORADIAN M.D.
Practice Location Address:
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50314-3034
Practice Phone: 515-288-1097
Practice Fax: 515-288-2847

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