Provider Demographics
NPI:1720651862
Name:QUEEN OF HEARTS CARDIOVASCULAR & FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:QUEEN OF HEARTS CARDIOVASCULAR & FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:192-472-8990
Mailing Address - Street 1:8684 CONNECTICUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5581
Mailing Address - Country:US
Mailing Address - Phone:219-472-8990
Mailing Address - Fax:219-472-0270
Practice Address - Street 1:8684 CONNECTICUT ST STE A
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5581
Practice Address - Country:US
Practice Address - Phone:219-472-8990
Practice Address - Fax:219-472-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty