Provider Demographics
NPI:1770749103
Name:CARDIOVASCULAR SPECIALISTS OF THE CUMBERLANDS PLLC
Entity type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS OF THE CUMBERLANDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHALHOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-864-5976
Mailing Address - Street 1:1406 W 5TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1688
Mailing Address - Country:US
Mailing Address - Phone:606-864-5976
Mailing Address - Fax:606-864-6828
Practice Address - Street 1:1406 W 5TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1688
Practice Address - Country:US
Practice Address - Phone:606-864-5976
Practice Address - Fax:606-864-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31517207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00736Medicare PIN