Basic Information
| Provider Information | |||||||||
| NPI: | 1649444548 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL CARDIOLOGY CONSULTANTS LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6090 STRATHMOOR DR | ||||||||
| Address2: | STE 6 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153950100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1848 DAIMLER RD | ||||||||
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| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611121019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152292500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2008 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | RAO | ||||||||
| AuthorizedOfficialFirstName: | AYYAGARI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8153950100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.