Provider Demographics
NPI:1679910327
Name:CARDIOVASCULAR CONSULTANTS & PREVENTIVE MEDICINE INSTITUTE, LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS & PREVENTIVE MEDICINE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-910-8976
Mailing Address - Street 1:8300 BROADWAY
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8602
Mailing Address - Country:US
Mailing Address - Phone:219-750-9389
Mailing Address - Fax:219-750-9681
Practice Address - Street 1:8300 BROADWAY
Practice Address - Street 2:SUITE 1A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8602
Practice Address - Country:US
Practice Address - Phone:219-750-9389
Practice Address - Fax:219-750-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty