Provider Demographics
NPI:1407025471
Name:INDIANA CARDIAC & VASCULAR CONSULTANTS
Entity Type:Organization
Organization Name:INDIANA CARDIAC & VASCULAR CONSULTANTS
Other - Org Name:CENTRAL INDIANA PULMONARY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HABIB
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KOMARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-887-7700
Mailing Address - Street 1:2209 JOHN R WOODEN DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1840
Mailing Address - Country:US
Mailing Address - Phone:765-346-7025
Mailing Address - Fax:765-349-6442
Practice Address - Street 1:2209 JOHN R WOODEN DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1840
Practice Address - Country:US
Practice Address - Phone:765-346-7025
Practice Address - Fax:765-349-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN677700Medicare PIN