Provider Demographics
NPI:1629177076
Name:INDIANA CARDIAC & VASCULAR CONSULTANTS
Entity Type:Organization
Organization Name:INDIANA CARDIAC & VASCULAR CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HABIB
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KOMARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-887-7700
Mailing Address - Street 1:1101 W JEFFERSON ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2147
Mailing Address - Country:US
Mailing Address - Phone:317-736-8383
Mailing Address - Fax:317-736-0790
Practice Address - Street 1:1101 W JEFFERSON ST
Practice Address - Street 2:SUITE J
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2147
Practice Address - Country:US
Practice Address - Phone:317-736-8383
Practice Address - Fax:317-736-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040158A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN677700Medicare PIN