Provider Demographics
NPI:1124714514
Name:CARDIOVASCULAR CLINIC OF ARIZONA PLLC
Entity type:Organization
Organization Name:CARDIOVASCULAR CLINIC OF ARIZONA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THASLIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-603-2177
Mailing Address - Street 1:11264 N 128TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4470
Mailing Address - Country:US
Mailing Address - Phone:240-603-2177
Mailing Address - Fax:
Practice Address - Street 1:2157 E BASELINE RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1544
Practice Address - Country:US
Practice Address - Phone:240-603-2177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty