Provider Demographics
NPI:1710922034
Name:CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUDMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-452-1345
Mailing Address - Street 1:2855 MITCHELL DR
Mailing Address - Street 2:#223
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1600
Mailing Address - Country:US
Mailing Address - Phone:925-277-1900
Mailing Address - Fax:925-277-1568
Practice Address - Street 1:5201 NORRIS CANYON RD
Practice Address - Street 2:#220
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5411
Practice Address - Country:US
Practice Address - Phone:925-277-1900
Practice Address - Fax:925-277-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ56225ZOtherBLUE SHIELD PROVIDER NUMBER
CAZZZ56225ZOtherBLUE SHIELD PROVIDER NUMBER