Provider Demographics
NPI:1225174824
Name:CARDIAC CARE ASSOCIATES
Entity Type:Organization
Organization Name:CARDIAC CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:H
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-922-3755
Mailing Address - Street 1:2852 BOUDINOT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2461
Mailing Address - Country:US
Mailing Address - Phone:513-922-3755
Mailing Address - Fax:513-922-3759
Practice Address - Street 1:2852 BOUDINOT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2461
Practice Address - Country:US
Practice Address - Phone:513-922-3755
Practice Address - Fax:513-922-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35027564207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0335408Medicare ID - Type Unspecified
9926091Medicare ID - Type Unspecified
OH0136061Medicare PIN
A71050Medicare UPIN