Provider Demographics
NPI:1750009197
Name:CARDIORENAL THERAPEUTICS TELEMED
Entity type:Organization
Organization Name:CARDIORENAL THERAPEUTICS TELEMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:REHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-721-7069
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-0516
Mailing Address - Country:US
Mailing Address - Phone:815-677-2161
Mailing Address - Fax:
Practice Address - Street 1:2374 N RIVER RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-9446
Practice Address - Country:US
Practice Address - Phone:815-677-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty