MEDICARE: PHOENICIAN CARDIAC CARE LLC

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	207RI0011X	Interventional Cardiology Physician
2	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1972113546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENICIAN CARDIAC CARE LLC

Provider Business Mailing Address
First Line	:	2228 W NORTHERN AVE STE B210
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-9336
Country	:	US
Telephone Number	:	480-444-7464
Fax Number	:	480-355-1798

Provider Business Practice Location Address
First Line	:	2228 W NORTHERN AVE # D-209
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-9369
Country	:	US
Telephone Number	:	480-444-7464
Fax Number	:	480-355-1798

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. PARAMVIR TULI
Credential	:
Telephone Number	:	480-323-0244

Provider Enumeration Date	:	08/07/2020
Last Update Date	:	09/11/2020

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