NPIViewer - Provider NPI 1427276773

NPI:	1427276773
Name:	ALLEN COUNTY CARDIOLOGY LLC
Entity type:	Organization
Organization Name:	ALLEN COUNTY CARDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	MANG. PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:	NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:	LAL
Authorized Official - Suffix:
Authorized Official - Credentials:	MD
Authorized Official - Phone:	260-423-1331
Mailing Address - Street 1:	604 W. BERRY ST
Mailing Address - Street 2:
Mailing Address - City:	FT WAYNE
Mailing Address - State:	IN
Mailing Address - Zip Code:	46802-2106
Mailing Address - Country:	US
Mailing Address - Phone:	260-423-1331
Mailing Address - Fax:	260-422-1046
Practice Address - Street 1:	604 W. BERRY ST
Practice Address - Street 2:
Practice Address - City:	FT WAYNE
Practice Address - State:	IN
Practice Address - Zip Code:	46802-2106
Practice Address - Country:	US
Practice Address - Phone:	260-423-1331
Practice Address - Fax:	260-422-1046
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2007-04-23
Last Update Date:	2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization	Group
Yes	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Multi-Specialty
No	207RG0300X	Allopathic & Osteopathic Physicians	Internal Medicine	Geriatric Medicine	Group - Multi-Specialty

State	Identifier ID	ID Type	Issuer
IN	1770692337	Other	LAL NPI
IN	200387750A	Medicaid
IN	1275642837	Other	MOHANDAS NPI
IN	200237610A	Medicaid
IN	200350400	Medicaid
IN	1922117571	Other	LOPEZ NPI
IN	200108750A	Medicaid
IN	1548379191	Other	AHUJA NIP
IN	200387750A	Medicaid
IN	200350400	Medicaid
IN	200237610A	Medicaid
IN	141360	Medicare PIN
IN	1922117571	Other	LOPEZ NPI
IN	141360B	Medicare ID - Type Unspecified	LOUIS A LOPEZ, MD
IN	100054800A	Medicare ID - Type Unspecified	SHASHI K AHUJA, MD
IN	C24211	Medicare UPIN
IN	200108750A	Medicaid