Provider Demographics
NPI:1477566487
Name:CARDIAC CARE SPECIALISTS PA
Entity Type:Organization
Organization Name:CARDIAC CARE SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-273-2378
Mailing Address - Street 1:7824 LAKE UNDERHILL RD
Mailing Address - Street 2:STE. E
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8201
Mailing Address - Country:US
Mailing Address - Phone:407-273-2378
Mailing Address - Fax:407-273-7868
Practice Address - Street 1:7824 LAKE UNDERHILL RD
Practice Address - Street 2:STE. E
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8201
Practice Address - Country:US
Practice Address - Phone:407-273-2378
Practice Address - Fax:407-273-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty