Basic Information
| Provider Information | |||||||||
| NPI: | 1831282177 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARDAMAN S NANDA INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MIDWEST CARDIOVASCULAR CONSULTANTS INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12266 DE PAUL DR | ||||||||
| Address2: | 205 | ||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630442514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142182300 | ||||||||
| FaxNumber: | 3142182319 | ||||||||
| Practice Location | |||||||||
| Address1: | 12266 DE PAUL DR | ||||||||
| Address2: | 205 | ||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630442514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142182300 | ||||||||
| FaxNumber: | 3142182319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2006 | ||||||||
| LastUpdateDate: | 09/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | NANDA | ||||||||
| AuthorizedOfficialFirstName: | ARDAMAN | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3142182300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 111672 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.