Provider Demographics
NPI:1699027763
Name:CONCIERGE CARDIOLOGY PC
Entity type:Organization
Organization Name:CONCIERGE CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-929-7900
Mailing Address - Street 1:1608 LINCOLNWAY
Mailing Address - Street 2:SUITE G
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5856
Mailing Address - Country:US
Mailing Address - Phone:219-476-0352
Mailing Address - Fax:219-531-0859
Practice Address - Street 1:824 LINCOLNWAY
Practice Address - Street 2:LOFT #2
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3411
Practice Address - Country:US
Practice Address - Phone:219-380-5724
Practice Address - Fax:219-575-7345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001043A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201117450AMedicaid
ININ1132Medicare PIN