Provider Demographics
NPI:1083696793
Name:PEDIATRIC CARDIOLOGY, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASAVIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAMOULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-288-1097
Mailing Address - Street 1:330 LAUREL ST
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3034
Mailing Address - Country:US
Mailing Address - Phone:515-288-1097
Mailing Address - Fax:515-288-2847
Practice Address - Street 1:330 LAUREL ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3034
Practice Address - Country:US
Practice Address - Phone:515-288-1097
Practice Address - Fax:515-288-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0183046Medicaid
IA0183046Medicaid