Provider Demographics
NPI:1538106711
Name:CARDIOVASCULAR CONSULTANTS PC
Entity type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-934-4200
Mailing Address - Street 1:10010 DONALD POWERS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-934-4200
Mailing Address - Fax:219-922-5904
Practice Address - Street 1:10010 DONALD POWERS DRIVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-934-4200
Practice Address - Fax:219-922-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200352790Medicaid
IN707050Medicare ID - Type Unspecified