MEDICARE: INDIANA CARDIAC & VASCULAR CONSULTANTS

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	174400000X	Specialist	01052617A	IN

General Provider Information

NPI Number	:	1326069162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA CARDIAC & VASCULAR CONSULTANTS

Provider Business Mailing Address
First Line	:	1350 E COUNTY LINE RD
Second Line	:	SUITE J
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0873
Country	:	US
Telephone Number	:	317-887-7588
Fax Number	:	317-887-7585

Provider Business Practice Location Address
First Line	:	1350 E COUNTY LINE RD
Second Line	:	SUITE J
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0873
Country	:	US
Telephone Number	:	317-887-7588
Fax Number	:	317-887-7585

Authorized Official
Title or Position	:	MANAGING PHYSICIAN
Name	:	ABBOUD KAWAK
Credential	:	M.D.
Telephone Number	:	317-887-7588

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	11/15/2007

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