Provider Demographics
NPI:1407013097
Name:CARDIOVASCULAR CLINICS PC
Entity Type:Organization
Organization Name:CARDIOVASCULAR CLINICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-756-1400
Mailing Address - Street 1:200 E 86TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6258
Mailing Address - Country:US
Mailing Address - Phone:219-756-1400
Mailing Address - Fax:219-756-1413
Practice Address - Street 1:1901 S HEATON ST
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-2325
Practice Address - Country:US
Practice Address - Phone:219-756-1400
Practice Address - Fax:219-756-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004087207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200195860Medicaid
IN169950Medicare PIN