Provider Demographics
NPI:1477629707
Name:ROMUALDO J. SEGUROLA, JR. M.D., P.A.
Entity Type:Organization
Organization Name:ROMUALDO J. SEGUROLA, JR. M.D., P.A.
Other - Org Name:SOUTH FLORIDA HEART AND LUNG INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-669-7173
Mailing Address - Street 1:3650 NW 82ND AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6658
Mailing Address - Country:US
Mailing Address - Phone:305-406-3596
Mailing Address - Fax:305-406-3599
Practice Address - Street 1:3650 NW 82ND AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6658
Practice Address - Country:US
Practice Address - Phone:305-406-3596
Practice Address - Fax:305-406-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277084900Medicaid
FL277084900Medicaid