Provider Demographics
NPI:1134564602
Name:CARDIOVASCULAR WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:CARDIOVASCULAR WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAMRON
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPRAROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-387-5273
Mailing Address - Street 1:16605 STATE ROAD 23
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1463
Mailing Address - Country:US
Mailing Address - Phone:574-387-5273
Mailing Address - Fax:574-855-3582
Practice Address - Street 1:16605 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1463
Practice Address - Country:US
Practice Address - Phone:574-387-5273
Practice Address - Fax:574-855-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty