Provider Demographics
NPI:1043409980
Name:CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUDMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-452-1345
Mailing Address - Street 1:2855 MITCHELL DR STE 223
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1609
Mailing Address - Country:US
Mailing Address - Phone:925-975-5944
Mailing Address - Fax:925-975-5943
Practice Address - Street 1:87 FENTON ST # 210A
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4100
Practice Address - Country:US
Practice Address - Phone:510-452-1345
Practice Address - Fax:510-452-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14622ZMedicare PIN