Provider Demographics
NPI:1942765607
Name:ADVANCED HEART AND VEIN CENTER INC
Entity Type:Organization
Organization Name:ADVANCED HEART AND VEIN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QAISAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-772-8040
Mailing Address - Street 1:805 E 144TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9210
Mailing Address - Country:US
Mailing Address - Phone:720-772-8040
Mailing Address - Fax:720-805-1551
Practice Address - Street 1:905 W 124TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-1718
Practice Address - Country:US
Practice Address - Phone:720-772-8040
Practice Address - Fax:720-805-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0051263OtherCOLORADO MEDICAL LICENSE