Provider Demographics
NPI:1942384862
Name:INLAND HEART AND VASCULAR MEDICAL ASSOC INC
Entity Type:Organization
Organization Name:INLAND HEART AND VASCULAR MEDICAL ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-883-8938
Mailing Address - Street 1:339 E HIGHLAND AVE SUITE 209
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404
Mailing Address - Country:US
Mailing Address - Phone:909-883-8938
Mailing Address - Fax:909-883-1739
Practice Address - Street 1:339 E HIGHLAND AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404
Practice Address - Country:US
Practice Address - Phone:909-883-8938
Practice Address - Fax:909-883-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0093120Medicaid
CAZZZ24852ZMedicare PIN