Provider Demographics
NPI:1619941531
Name:CARDIOVASCULAR INSTITUTE OF ARIZONA
Entity Type:Organization
Organization Name:CARDIOVASCULAR INSTITUTE OF ARIZONA
Other - Org Name:SUNRISE CARDIOVASCULAR CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:M. JAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-962-9494
Mailing Address - Street 1:215 S POWER RD
Mailing Address - Street 2:STE 106
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5235
Mailing Address - Country:US
Mailing Address - Phone:480-962-9494
Mailing Address - Fax:480-962-8140
Practice Address - Street 1:215 S POWER RD
Practice Address - Street 2:STE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5235
Practice Address - Country:US
Practice Address - Phone:480-962-9494
Practice Address - Fax:480-962-8140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CR1147Medicare PIN
AZZWDBTVMedicare PIN