Provider Demographics
NPI:1033525779
Name:US CARDIO OF SA, LLC
Entity Type:Organization
Organization Name:US CARDIO OF SA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RADOSLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:KIESZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-272-0098
Mailing Address - Street 1:6830 HEUERMANN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-9665
Mailing Address - Country:US
Mailing Address - Phone:210-802-4350
Mailing Address - Fax:210-802-4351
Practice Address - Street 1:6830 HEUERMANN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-9665
Practice Address - Country:US
Practice Address - Phone:210-802-4350
Practice Address - Fax:210-802-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
TX130228261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX561608Medicare UPIN