Provider Demographics
NPI:1952617011
Name:TEAM CARDIOVASCULAR CONSULTANTS
Entity Type:Organization
Organization Name:TEAM CARDIOVASCULAR CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBLASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-703-8555
Mailing Address - Street 1:3809 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2860
Mailing Address - Country:US
Mailing Address - Phone:830-703-8555
Mailing Address - Fax:830-703-8334
Practice Address - Street 1:3809 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2860
Practice Address - Country:US
Practice Address - Phone:830-703-8555
Practice Address - Fax:830-703-8334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7944207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG72933Medicare UPIN