Provider Demographics
NPI:1053690735
Name:CRESCENT CARDIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:CRESCENT CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYAK
Authorized Official - Middle Name:SHAMEEM
Authorized Official - Last Name:KAMILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-794-3511
Mailing Address - Street 1:8401 MEMORIAL LN
Mailing Address - Street 2:#7445
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2285
Mailing Address - Country:US
Mailing Address - Phone:214-794-3511
Mailing Address - Fax:214-291-5829
Practice Address - Street 1:8401 MEMORIAL LN
Practice Address - Street 2:#7445
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2285
Practice Address - Country:US
Practice Address - Phone:214-794-3511
Practice Address - Fax:214-291-5829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4507207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164642666OtherINDIVIDUAL NPI