Organization
CARDIAC RENAL & VASCULAR ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUROTIMI JOHN BADERO MD (REGISTERED AGENT)
(601) 750-5736
Entity
Organization
Contact information
Practice address
5240 ROBINSON ROAD EXT, JACKSON, MS 39204-4276
(601) 398-0904
(601) 398-2149
Mailing address
5240 ROBINSON ROAD EXT, JACKSON, MS 39204-4276
(601) 398-0904
(601) 398-2149
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
21527
MS
207RN0300X
Nephrology Physician
21527
MS
Other
Enumeration date
10/12/2011
Last updated
12/11/2013
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