Provider Demographics
NPI:1710583315
Name:HEARTFUL CARDIOLOGY, PLLC
Entity Type:Organization
Organization Name:HEARTFUL CARDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMOLAFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-880-7887
Mailing Address - Street 1:2800 E BROAD ST STE 204
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6411
Mailing Address - Country:US
Mailing Address - Phone:817-752-5242
Mailing Address - Fax:205-894-7685
Practice Address - Street 1:2800 E BROAD ST STE 204
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6411
Practice Address - Country:US
Practice Address - Phone:817-752-5242
Practice Address - Fax:205-894-7685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX419572901Medicaid
TX419572901Medicaid