Provider Demographics
NPI:1447361928
Name:THE HEART AND VASCULAR CLINIC, P.C.
Entity type:Organization
Organization Name:THE HEART AND VASCULAR CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OVAIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:812-277-9692
Mailing Address - Street 1:PO BOX 6687
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-6687
Mailing Address - Country:US
Mailing Address - Phone:812-330-0909
Mailing Address - Fax:812-330-0909
Practice Address - Street 1:3251 SHAWNEE DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421
Practice Address - Country:US
Practice Address - Phone:812-277-9692
Practice Address - Fax:812-277-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044272A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200503540AMedicaid
IN222950AMedicare ID - Type Unspecified