Organization
LAKESIDE HEART AND VASCULAR CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FADI ATASSI M.D. (OWNER/MEMBER)
(928) 453-2727
Entity
Organization
Contact information
Practice address
1741 MESQUITE AVE, SUITE A100, LAKE HAVASU CITY, AZ 86403-5695
(928) 453-2727
(928) 453-2828
Mailing address
PO BOX 3539, LAKE HAVASU CITY, AZ 86405-3539
(928) 453-2727
(928) 453-2828
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
44211
AZ
207RI0011X
Interventional Cardiology Physician
Primary
44211
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
604490
—
AZ
01
—
P-1663566-8
ARIZONA CORPORATION COMMISSION FILING NUMBER
AZ
Enumeration date
03/08/2011
Last updated
07/20/2011
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