Provider Demographics
NPI:1356892558
Name:PREMIER CARDIOVASCULAR CARE OF DALLAS, PLLC
Entity type:Organization
Organization Name:PREMIER CARDIOVASCULAR CARE OF DALLAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-205-8171
Mailing Address - Street 1:8144 WALNUT HILL LN STE 450
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0906
Mailing Address - Country:US
Mailing Address - Phone:469-513-2666
Mailing Address - Fax:469-513-2667
Practice Address - Street 1:1018 E WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4914
Practice Address - Country:US
Practice Address - Phone:469-513-2666
Practice Address - Fax:469-513-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-23
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty