Organization
DWT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK CHUTICH (ADMINISTRATIVE ASSISTANT)
(512) 615-6224
Entity
Organization
Contact information
Practice address
1301 W 38TH ST, SUITE 705, AUSTIN, TX 78705-1000
(512) 617-6000
Mailing address
5301 RIATA PARK COURT, BLDG. D, STE. 200, AUSTIN, TX 78727-3438
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
Other
Enumeration date
11/11/2009
Last updated
10/15/2010
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