Provider Demographics
NPI:1689128019
Name:MIDWEST HEART INSTITUTE
Entity Type:Organization
Organization Name:MIDWEST HEART INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUHASIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-517-0505
Mailing Address - Street 1:9225 CADDYSHACK CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1439 US HIGHWAY 61
Practice Address - Street 2:STE A
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4153
Practice Address - Country:US
Practice Address - Phone:636-931-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty