MEDICARE: CARDIOLOGY CONSULTANTS LTD

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1497999049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOLOGY CONSULTANTS LTD

Provider Business Mailing Address
First Line	:	PO BOX 4241
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63006-4241
Country	:	US
Telephone Number	:	314-560-1811
Fax Number	:

Provider Business Practice Location Address
First Line	:	14855 N OUTER 40
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2026
Country	:	US
Telephone Number	:	636-532-0150
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN RADKE
Credential	:	MD
Telephone Number	:	314-560-1811

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	04/27/2009

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