Provider Demographics
NPI:1750445060
Name:CARDIAC ASSOCIATES MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:CARDIAC ASSOCIATES MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:FLEISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-990-5665
Mailing Address - Street 1:16161 VENTURA BLVD
Mailing Address - Street 2:#812
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2522
Mailing Address - Country:US
Mailing Address - Phone:818-990-5665
Mailing Address - Fax:
Practice Address - Street 1:16133 VENTURA BLVD
Practice Address - Street 2:SUITE 1180
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2403
Practice Address - Country:US
Practice Address - Phone:818-990-5665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ70768ZMedicaid
CAZZZ70768ZMedicaid