Provider Demographics
NPI:1902985443
Name:CARDIAC CARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CARDIAC CARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGALOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-662-0077
Mailing Address - Street 1:1205 S MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3677
Mailing Address - Country:US
Mailing Address - Phone:219-662-0077
Mailing Address - Fax:219-661-2155
Practice Address - Street 1:1205 S MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3677
Practice Address - Country:US
Practice Address - Phone:219-662-0077
Practice Address - Fax:219-661-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100214840AMedicaid
IN100214840AMedicaid