Provider Demographics
NPI:1417128372
Name:CARDIOLOGY DIAGNOSTICS, LTD.
Entity Type:Organization
Organization Name:CARDIOLOGY DIAGNOSTICS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-966-9888
Mailing Address - Street 1:2325 DOUGHERTY FERRY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3356
Mailing Address - Country:US
Mailing Address - Phone:314-966-9888
Mailing Address - Fax:314-966-5957
Practice Address - Street 1:1101 WEBER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3326
Practice Address - Country:US
Practice Address - Phone:573-701-0222
Practice Address - Fax:573-701-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty