Provider Demographics
NPI:1083857056
Name:ALKEYLANI CARDIOLOGY AND FAMILY CARE, LLC
Entity Type:Organization
Organization Name:ALKEYLANI CARDIOLOGY AND FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABD
Authorized Official - Middle Name:U
Authorized Official - Last Name:ALKEYLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-129-2077
Mailing Address - Street 1:3 BOULDER LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CTR
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1105
Mailing Address - Country:US
Mailing Address - Phone:860-429-2077
Mailing Address - Fax:860-429-2077
Practice Address - Street 1:3 BOULDER LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD CTR
Practice Address - State:CT
Practice Address - Zip Code:06250-1105
Practice Address - Country:US
Practice Address - Phone:860-429-2077
Practice Address - Fax:860-429-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035596207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H34831Medicare UPIN