Provider Demographics
NPI:1598021248
Name:RADIN CARDIOVASCULAR MEDICAL GROUP INC
Entity Type:Organization
Organization Name:RADIN CARDIOVASCULAR MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RADIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-722-7555
Mailing Address - Street 1:1501 SUPERIOR AVE
Mailing Address - Street 2:#312
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3600
Mailing Address - Country:US
Mailing Address - Phone:949-722-7555
Mailing Address - Fax:
Practice Address - Street 1:1501 SUPERIOR AVE
Practice Address - Street 2:#312
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3600
Practice Address - Country:US
Practice Address - Phone:949-722-7555
Practice Address - Fax:949-515-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56739207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGC590AOtherMEDICARE P-TAN
CAG56739OtherMEDICAL LICENSE