Provider Demographics
NPI:1720225808
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:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-975-5944
Mailing Address - Street 1:2855 MITCHELL DR STE 223
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1609
Mailing Address - Country:US
Mailing Address - Phone:925-975-5930
Mailing Address - Fax:925-975-5941
Practice Address - Street 1:6380 CLARK AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3036
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:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty