Organization
COASTAL CARDIOLOLGY & VASCULAR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BALA NANDIGAM M.D. (PRESIDENT)
(941) 625-6187
Entity
Organization
Contact information
Practice address
1620 TAMIAMI TRL, SUITE 300, PORT CHARLOTTE, FL 33948-4015
(941) 625-6187
(941) 625-7887
Mailing address
1620 TAMIAMI TRL, SUITE 300, PORT CHARLOTTE, FL 33948-4015
(941) 625-6187
(941) 625-7887
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
Other
Enumeration date
10/15/2011
Last updated
10/15/2011
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