MEDICARE: MICHAEL NAZARIAN HEART & VASCULAR

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1780548123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL NAZARIAN HEART & VASCULAR

Provider Business Mailing Address
First Line	:	757 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2522
Country	:	US
Telephone Number	:	817-336-4454
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL NAZARIAN
Credential	:	MD
Telephone Number	:	817-896-0251

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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