Provider Demographics
NPI:1912913526
Name:CARDIOVASCULAR SURGERY WTWK
Entity Type:Organization
Organization Name:CARDIOVASCULAR SURGERY WTWK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-4944
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-836-4944
Mailing Address - Fax:219-836-5852
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-4944
Practice Address - Fax:219-836-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
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