Provider Demographics
NPI:1053505255
Name:CARDIOVASCULAR CENTER OF MIAMI LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR CENTER OF MIAMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:CUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-487-3334
Mailing Address - Street 1:10020 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3946
Mailing Address - Country:US
Mailing Address - Phone:305-487-3334
Mailing Address - Fax:305-487-3323
Practice Address - Street 1:10020 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3946
Practice Address - Country:US
Practice Address - Phone:305-487-3334
Practice Address - Fax:305-487-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32214CMedicare PIN
FL42269Medicare PIN
FL12634Medicare PIN