Provider Demographics
NPI:1548438716
Name:SAN TAN CARDIOVASCULAR CENTER LLC
Entity type:Organization
Organization Name:SAN TAN CARDIOVASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZELALEM
Authorized Official - Middle Name:
Authorized Official - Last Name:YILMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-390-3773
Mailing Address - Street 1:6859 E REMBRANDT AVE
Mailing Address - Street 2:SUIT 117
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3628
Mailing Address - Country:US
Mailing Address - Phone:480-390-3773
Mailing Address - Fax:
Practice Address - Street 1:6859 E REMBRANDT AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3628
Practice Address - Country:US
Practice Address - Phone:480-390-3773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25431207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty