Provider Demographics
NPI:1871822239
Name:CARDIO IMAGE INC
Entity type:Organization
Organization Name:CARDIO IMAGE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAKILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-767-8554
Mailing Address - Street 1:450 W CENTRAL PKWY
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2436
Mailing Address - Country:US
Mailing Address - Phone:407-767-8554
Mailing Address - Fax:407-767-9121
Practice Address - Street 1:450 W CENTRAL PKWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2436
Practice Address - Country:US
Practice Address - Phone:407-767-8554
Practice Address - Fax:407-767-9121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORLANDO HEART SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-15
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84848261QR0200X, 335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier