Provider Demographics
NPI:1437287158
Name:CARDIOLOGY CENTER OF ENGLEWOOD PA
Entity Type:Organization
Organization Name:CARDIOLOGY CENTER OF ENGLEWOOD PA
Other - Org Name:CARDIOLOGY CENTER OF ENGLEWOOD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PFAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-475-5621
Mailing Address - Street 1:601 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223
Mailing Address - Country:US
Mailing Address - Phone:941-475-5621
Mailing Address - Fax:941-474-8587
Practice Address - Street 1:601 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223
Practice Address - Country:US
Practice Address - Phone:941-475-5621
Practice Address - Fax:941-474-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75359207RC0000X
207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021673900Medicaid
FLK2600Medicare UPIN
FL021673900Medicaid