Provider Demographics
NPI:1164887329
Name:HEART AND VASCULAR CENTER, LLC
Entity Type:Organization
Organization Name:HEART AND VASCULAR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ASFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-934-4210
Mailing Address - Street 1:604 CAMBRIDGE CT
Mailing Address - Street 2:1B
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2458
Mailing Address - Country:US
Mailing Address - Phone:219-934-4210
Mailing Address - Fax:
Practice Address - Street 1:604 CAMBRIDGE CT
Practice Address - Street 2:1B
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2458
Practice Address - Country:US
Practice Address - Phone:219-934-4210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053031A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING63669Medicare UPIN