Provider Demographics
NPI:1316155807
Name:CARDIOLOGY CONSULTANTS OF EAST TEXAS PA
Entity type:Organization
Organization Name:CARDIOLOGY CONSULTANTS OF EAST TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEKULIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-577-7070
Mailing Address - Street 1:2015 MULBERRY AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2312
Mailing Address - Country:US
Mailing Address - Phone:903-577-7070
Mailing Address - Fax:903-577-7072
Practice Address - Street 1:2015 MULBERRY AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2312
Practice Address - Country:US
Practice Address - Phone:903-577-7070
Practice Address - Fax:903-577-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04780363A00000X
TXM2087207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB157920OtherMEDICARE PTAN FOR PA
TX1104879915OtherINDIVIDUAL NPI FOR PA
TX1265464564OtherINDIVIDUAL NPI
TX1766404-01Medicaid
TXI39526Medicare UPIN
TX8F5915Medicare PIN