Provider Demographics
NPI:1902815897
Name:CEDARS HEART CLINIC, LLC
Entity Type:Organization
Organization Name:CEDARS HEART CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELGHOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-917-5900
Mailing Address - Street 1:1960 W FRYE RD
Mailing Address - Street 2:BUILDING A, SUITE 5
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6238
Mailing Address - Country:US
Mailing Address - Phone:480-917-5900
Mailing Address - Fax:480-917-2255
Practice Address - Street 1:1960 W FRYE RD
Practice Address - Street 2:BUILDING A, SUITE 5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6238
Practice Address - Country:US
Practice Address - Phone:480-917-5900
Practice Address - Fax:480-917-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29317207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ569048Medicaid
AZH54379Medicare UPIN
AZ569048Medicaid