Provider Demographics
NPI:1033174453
Name:HEART & VASCULAR CENTER OF SARASOTA INC
Entity Type:Organization
Organization Name:HEART & VASCULAR CENTER OF SARASOTA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:BREDLAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-365-0433
Mailing Address - Street 1:PO BOX 5699
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-5699
Mailing Address - Country:US
Mailing Address - Phone:941-365-0433
Mailing Address - Fax:941-954-2064
Practice Address - Street 1:1851 HAWTHORNE STREET
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2945
Practice Address - Country:US
Practice Address - Phone:941-365-0433
Practice Address - Fax:941-954-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264865200Medicaid
FLCK3972OtherMCR RAILROAD
FL264865200Medicaid
FLCK3972OtherMCR RAILROAD