Provider Demographics
NPI:1306849773
Name:MIAMI CARDIOPULMONARY INSTITUTE LLC
Entity Type:Organization
Organization Name:MIAMI CARDIOPULMONARY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ILDEFONSO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAS JR.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-448-9990
Mailing Address - Street 1:3200 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7239
Mailing Address - Country:US
Mailing Address - Phone:305-448-9990
Mailing Address - Fax:305-448-9993
Practice Address - Street 1:3200 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7239
Practice Address - Country:US
Practice Address - Phone:305-448-9990
Practice Address - Fax:305-448-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLN/A-OP CARDIAC CATH261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268091200Medicaid
FL45678OtherNEIGHBORHOOD HEALTH PLAN
FLV2751OtherBLUE CROSS BLUE SHIELD
FL3321067OtherAETNA HMO
FL3556558OtherAETNA
FL7388537OtherAETNA NON-HMO
FLV3352OtherBLUE CROSS BLUE SHIELD
FLV3352OtherBLUE CROSS BLUE SHIELD (CATH)
FL291498OtherAVMED
FL3556558OtherAETNA
FL=========OtherPREFERRED CARE PARTNERS
FLV2751OtherBLUE CROSS BLUE SHIELD
FL=========OtherLEON MEDICAL CENTER
FL268091200Medicaid
FLV3352OtherBLUE CROSS BLUE SHIELD (CATH)
FL=========OtherHEALTHSUN HEALTH PALNS, INC.
FL45678OtherNEIGHBORHOOD HEALTH PLAN
FL=========OtherHEALTH SUN
FL=========OtherMEDICA HEALTH PLANS