Basic Information
| Provider Information | |||||||||
| NPI: | 1194106385 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL CARDIOVASCULAR CONSULTANTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3904 CORTEZ RD W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342103111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417522840 | ||||||||
| FaxNumber: | 8552534836 | ||||||||
| Practice Location | |||||||||
| Address1: | 3904 CORTEZ RD W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342103111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417522840 | ||||||||
| FaxNumber: | 9413451951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2015 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | KRISHNAMURTHY | ||||||||
| AuthorizedOfficialFirstName: | ASHOK | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9417522840 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.