Provider Demographics
NPI:1437483385
Name:CARDIOVASCULAR CENTER PLLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:KRESOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-669-8161
Mailing Address - Street 1:1413 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-6310
Mailing Address - Country:US
Mailing Address - Phone:928-669-8161
Mailing Address - Fax:928-669-8171
Practice Address - Street 1:1413 W 16TH ST
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-6310
Practice Address - Country:US
Practice Address - Phone:928-669-8161
Practice Address - Fax:928-669-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26534207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty