Provider Demographics
NPI:1205123387
Name:COMPREHENSIVE CARDIOVASCULAR CONSULTANTS, INC.
Entity type:Organization
Organization Name:COMPREHENSIVE CARDIOVASCULAR CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIKORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-849-0923
Mailing Address - Street 1:3760 S LINDBERGH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1374
Mailing Address - Country:US
Mailing Address - Phone:314-849-0923
Mailing Address - Fax:314-849-5716
Practice Address - Street 1:3760 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1374
Practice Address - Country:US
Practice Address - Phone:314-849-0923
Practice Address - Fax:314-849-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR4P45293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODG2079OtherRAILROAD MEDICARE
ILIL1797OtherIL MEDICARE IDTF PTAN
MOMA1570OtherMO MEDICARE IDTF PTAN