Provider Demographics
NPI:1669133260
Name:EAU CLAIRE HEART INSTITUTE
Entity type:Organization
Organization Name:EAU CLAIRE HEART INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABD
Authorized Official - Middle Name:G
Authorized Official - Last Name:KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-831-4444
Mailing Address - Street 1:659 WEST HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6925
Mailing Address - Country:US
Mailing Address - Phone:715-831-4444
Mailing Address - Fax:920-526-5248
Practice Address - Street 1:659 WEST HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6925
Practice Address - Country:US
Practice Address - Phone:715-831-4444
Practice Address - Fax:920-526-5248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1386600310Other1386600310
WI1386600310Medicaid