Provider Demographics
NPI:1417936063
Name:HEARTLAND CARDIOLOGY GROUP PA
Entity Type:Organization
Organization Name:HEARTLAND CARDIOLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRAKANT
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-471-1010
Mailing Address - Street 1:4639 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2177
Mailing Address - Country:US
Mailing Address - Phone:863-471-1010
Mailing Address - Fax:863-382-3398
Practice Address - Street 1:4639 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2177
Practice Address - Country:US
Practice Address - Phone:863-471-1010
Practice Address - Fax:863-382-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262227100Medicaid
FLK6659Medicare ID - Type Unspecified