Provider Demographics
NPI:1619007572
Name:INDIANA CARDIOVASCULAR ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:INDIANA CARDIOVASCULAR ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:DUCK
Authorized Official - Last Name:YOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-4300
Mailing Address - Street 1:931 FRAN LIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3540
Mailing Address - Country:US
Mailing Address - Phone:219-836-4300
Mailing Address - Fax:219-836-0033
Practice Address - Street 1:931 FRAN LIN PKWY
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3540
Practice Address - Country:US
Practice Address - Phone:219-836-4300
Practice Address - Fax:219-836-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003901A2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDG4828OtherRAILROAD MEDICARE
INDG4828OtherRAILROAD MEDICARE