Provider Demographics
NPI:1548224751
Name:HEART CENTER OF LAKE COUNTY,P.C.
Entity Type:Organization
Organization Name:HEART CENTER OF LAKE COUNTY,P.C.
Other - Org Name:ANDRE K ARTIS, M.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-884-9180
Mailing Address - Street 1:5800 BROADWAY
Mailing Address - Street 2:SUITE A-J
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2601
Mailing Address - Country:US
Mailing Address - Phone:219-884-9180
Mailing Address - Fax:
Practice Address - Street 1:5800 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2601
Practice Address - Country:US
Practice Address - Phone:219-884-9180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100102810Medicaid
IN100102810Medicaid