Provider Demographics
NPI:1225323751
Name:FLORIDA INSTITUTE FOR CARDIOVASCULAR CARE PA
Entity Type:Organization
Organization Name:FLORIDA INSTITUTE FOR CARDIOVASCULAR CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-967-6550
Mailing Address - Street 1:2905 N COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3957
Mailing Address - Country:US
Mailing Address - Phone:954-967-6550
Mailing Address - Fax:
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-967-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site