Provider Demographics
NPI:1477569291
Name:INTRACOASTAL CARDIAC SERVICES GEN PTRS
Entity Type:Organization
Organization Name:INTRACOASTAL CARDIAC SERVICES GEN PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANESTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-278-3323
Mailing Address - Street 1:150 S PINE ISLAND RD STE 390
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2667
Mailing Address - Country:US
Mailing Address - Phone:954-726-1808
Mailing Address - Fax:954-726-1820
Practice Address - Street 1:900 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2519
Practice Address - Country:US
Practice Address - Phone:561-278-3323
Practice Address - Fax:561-274-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72193OtherBCBS
FLCI9848OtherRAILROAD MEDICARE
FL062451900Medicaid
FL062451900Medicaid