Provider Demographics
NPI:1447398284
Name:CARDIOVASCULAR & THORACIC SURGEONS OF GREATER FT LAUDERDALE, LLP
Entity Type:Organization
Organization Name:CARDIOVASCULAR & THORACIC SURGEONS OF GREATER FT LAUDERDALE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:F
Authorized Official - Last Name:TABRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-462-4413
Mailing Address - Street 1:1625 SE 3RD AVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2521
Mailing Address - Country:US
Mailing Address - Phone:954-462-4413
Mailing Address - Fax:
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-462-4413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036437208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58823Medicare UPIN
FLD78848Medicare UPIN
FLE92492Medicare UPIN
H75952Medicare UPIN