Provider Demographics
NPI:1184618704
Name:PIONEER CARDIOVASCULAR CONSULTANTS, P.C.
Entity type:Organization
Organization Name:PIONEER CARDIOVASCULAR CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-345-0034
Mailing Address - Street 1:2149 E BASELINE RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1539
Mailing Address - Country:US
Mailing Address - Phone:480-345-0034
Mailing Address - Fax:480-345-4033
Practice Address - Street 1:2149 E BASELINE RD
Practice Address - Street 2:SUITE #103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1539
Practice Address - Country:US
Practice Address - Phone:480-345-0034
Practice Address - Fax:480-345-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26872174400000X
AZ27343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ462490Medicaid
AZ1669421921OtherNPI
AZ447484Medicaid
AZ1255389953OtherNPI
AZ1669421921OtherNPI
AZG88875Medicare UPIN
AZ100168Medicare PIN
AZ1255389953OtherNPI