MEDICARE: CARDIOVASCULAR THORACIC ASSOCIATES OF LAKE COUNTY, 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
1	2086S0129X	Vascular Surgery Physician
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1639133879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR THORACIC ASSOCIATES OF LAKE COUNTY, P.C.

Provider Business Mailing Address
First Line	:	9201 CALUMET AVE
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-2807
Country	:	US
Telephone Number	:	219-836-2022
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 FIR ST
Second Line	:	SUITE 210
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3052
Country	:	US
Telephone Number	:	219-228-4776
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID JAYAKAR
Credential	:	M.D.
Telephone Number	:	219-836-2022

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/18/2008

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