# BAY AREA CARDIOVASCULAR MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659438513
- **Authorized official:** DR. JOHN THOMAS MEHIGAN M.D. (PRESIDENT)
- **Authorized official phone:** (510) 791-1005

## Contact information

- **Practice address:** 39300 CIVIC CENTER DR, \#140, FREMONT, CA 94538-2338
- **Practice address phone:** (510) 791-1005
- **Practice address fax:** (510) 791-2874
- **Mailing address:** 39300 CIVIC CENTER DR, \#140, FREMONT, CA 94538-2338
- **Mailing address phone:** (510) 791-1005
- **Mailing address fax:** (510) 791-2874

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | G16196 | CA | Yes |

## Other

- **Enumeration date:** 01/02/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZZ80072Z | — | CA |