Provider Demographics
NPI:1962470971
Name:THE HEART CLINIC PC
Entity Type:Organization
Organization Name:THE HEART CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:KHALED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-747-6535
Mailing Address - Street 1:10293 N 92ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4565
Mailing Address - Country:US
Mailing Address - Phone:480-747-6535
Mailing Address - Fax:480-747-6538
Practice Address - Street 1:10293 N 92ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4565
Practice Address - Country:US
Practice Address - Phone:480-747-6535
Practice Address - Fax:480-747-6538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ69809Medicare ID - Type Unspecified