Provider Demographics
NPI:1265705982
Name:ADVANCED CARDIOVASCULAR CARE, PC
Entity type:Organization
Organization Name:ADVANCED CARDIOVASCULAR CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-947-6017
Mailing Address - Street 1:1500 S LAKE PARK AVE
Mailing Address - Street 2:110
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6638
Mailing Address - Country:US
Mailing Address - Phone:219-947-6017
Mailing Address - Fax:219-947-6018
Practice Address - Street 1:1500 S LAKE PARK AVE
Practice Address - Street 2:110
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6638
Practice Address - Country:US
Practice Address - Phone:219-947-6017
Practice Address - Fax:219-947-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN207RC0000XOtherTAXONOMY CODE