Provider Demographics
NPI:1275572257
Name:SOUTH FLORIDA CARDIOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA CARDIOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-672-9989
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:STE 300
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-672-9989
Mailing Address - Fax:305-672-3284
Practice Address - Street 1:1601 N PALM AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3200
Practice Address - Country:US
Practice Address - Phone:954-432-1511
Practice Address - Fax:305-672-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 49144207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77166AMedicare PIN