Provider Demographics
NPI:1679599823
Name:ADVANCED CARDIOVASCULAR DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:ADVANCED CARDIOVASCULAR DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-253-8195
Mailing Address - Street 1:21755 BROOKPARK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3200
Mailing Address - Country:US
Mailing Address - Phone:440-777-6305
Mailing Address - Fax:440-777-2330
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-253-8195
Practice Address - Fax:330-253-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2050104Medicaid
OH2050104Medicaid