Provider Demographics
NPI:1457384661
Name:UNIVERSITY CARDIAC & THORACIC SURGICAL GROUP, INC.
Entity type:Organization
Organization Name:UNIVERSITY CARDIAC & THORACIC SURGICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:VANHEECKEREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-844-3053
Mailing Address - Street 1:5910 LANDERBROOK DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6508
Mailing Address - Country:US
Mailing Address - Phone:440-684-5979
Mailing Address - Fax:440-449-1555
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2054806Medicaid
OHCN7867OtherRAILROAD MEDICARE
OHCN7867OtherRAILROAD MEDICARE
OH2054806Medicaid