MEDICARE: OPTIMA HEARTCARE, INC.

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
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1124015763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMA HEARTCARE, INC.

Provider Business Mailing Address
First Line	:	13358 MANCHESTER RD
Second Line	:	SUITE 120
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1730
Country	:	US
Telephone Number	:	314-965-3023
Fax Number	:	314-965-1477

Provider Business Practice Location Address
First Line	:	13358 MANCHESTER RD
Second Line	:	SUITE 120
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1730
Country	:	US
Telephone Number	:	314-965-3023
Fax Number	:	314-965-1477

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN R. RAABE
Credential	:	M.D.
Telephone Number	:	314-965-3023

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	09/05/2007

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Directions to “OPTIMA HEARTCARE, INC. ” Practice Location

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