Provider Demographics
NPI:1972113546
Name:PHOENICIAN CARDIAC CARE LLC
Entity Type:Organization
Organization Name:PHOENICIAN CARDIAC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PARAMVIR
Authorized Official - Middle Name:
Authorized Official - Last Name:TULI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-323-0244
Mailing Address - Street 1:2228 W NORTHERN AVE STE B210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-9336
Mailing Address - Country:US
Mailing Address - Phone:480-444-7464
Mailing Address - Fax:480-355-1798
Practice Address - Street 1:2228 W NORTHERN AVE # D-209
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-9369
Practice Address - Country:US
Practice Address - Phone:480-444-7464
Practice Address - Fax:480-355-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty