Provider Demographics
NPI:1467487983
Name:CARDIOLOGY SPECIALISTS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CARDIOLOGY SPECIALISTS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAUSTUBH
Authorized Official - Middle Name:VASANT
Authorized Official - Last Name:PATANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-352-3937
Mailing Address - Street 1:3770 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2527
Mailing Address - Country:US
Mailing Address - Phone:951-352-3937
Mailing Address - Fax:951-352-2839
Practice Address - Street 1:3770 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2527
Practice Address - Country:US
Practice Address - Phone:951-352-3937
Practice Address - Fax:951-352-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA236270OtherPTAN