Provider Demographics
NPI:1730447012
Name:INTERVENTIONAL CLINICS OF AMERICA LLC
Entity type:Organization
Organization Name:INTERVENTIONAL CLINICS OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-460-4502
Mailing Address - Street 1:8300 BROADWAY
Mailing Address - Street 2:SUITE A1
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8602
Mailing Address - Country:US
Mailing Address - Phone:219-779-8346
Mailing Address - Fax:925-380-3168
Practice Address - Street 1:8300 BROADWAY
Practice Address - Street 2:SUITE A1
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8602
Practice Address - Country:US
Practice Address - Phone:219-779-8346
Practice Address - Fax:925-380-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty