Provider Demographics
NPI:1063547891
Name:CARDIOVASCULAR MEDICINE ASSOC., P.A.
Entity type:Organization
Organization Name:CARDIOVASCULAR MEDICINE ASSOC., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:IYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-988-2223
Mailing Address - Street 1:7737 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 955
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1807
Mailing Address - Country:US
Mailing Address - Phone:713-988-2223
Mailing Address - Fax:713-988-2232
Practice Address - Street 1:7737 SOUTHWEST FWY
Practice Address - Street 2:SUITE 955
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-988-2223
Practice Address - Fax:713-988-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083673601Medicaid
TX00L21LMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TX083673601Medicaid