Basic Information
| Provider Information | |||||||||
| NPI: | 1548331408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOVASCULAR CONSULTANTS PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98 | ||||||||
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| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423020098 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 E PARRISH AVE | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423033222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709262998 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUPTA | ||||||||
| AuthorizedOfficialFirstName: | MUKESH | ||||||||
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| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 2709262998 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.