Provider Demographics
NPI:1659438513
Name:BAY AREA CARDIOVASCULAR MEDICAL GROUP
Entity Type:Organization
Organization Name:BAY AREA CARDIOVASCULAR MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MEHIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-791-1005
Mailing Address - Street 1:39300 CIVIC CENTER DR
Mailing Address - Street 2:#140
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2338
Mailing Address - Country:US
Mailing Address - Phone:510-791-1005
Mailing Address - Fax:510-791-2874
Practice Address - Street 1:39300 CIVIC CENTER DR
Practice Address - Street 2:#140
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2338
Practice Address - Country:US
Practice Address - Phone:510-791-1005
Practice Address - Fax:510-791-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG161962086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80072ZMedicaid
CAZZZ80072ZMedicaid