Provider Demographics
NPI:1275246290
Name:MY HEART SPARK PC
Entity Type:Organization
Organization Name:MY HEART SPARK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY-ANN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-261-8094
Mailing Address - Street 1:1200 BRICKELL AVE STE 1950
Mailing Address - Street 2:#1005
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3298
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 BRICKELL AVE STE 1950
Practice Address - Street 2:#1005
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3298
Practice Address - Country:US
Practice Address - Phone:414-261-8094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty