Provider Demographics
NPI:1407823636
Name:CHANDLER CARDIOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:CHANDLER CARDIOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHTISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-782-0101
Mailing Address - Street 1:PO BOX 6850
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6850
Mailing Address - Country:US
Mailing Address - Phone:480-782-0101
Mailing Address - Fax:480-782-1251
Practice Address - Street 1:1850 W FRYE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6232
Practice Address - Country:US
Practice Address - Phone:480-782-0101
Practice Address - Fax:480-782-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ468646Medicaid
AZ468646Medicaid
AZ77731Medicare ID - Type Unspecified