Provider Demographics
NPI:1538302955
Name:CARDIOMEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:CARDIOMEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOURI
Authorized Official - Middle Name:
Authorized Official - Last Name:NASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-935-4959
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33008-0246
Mailing Address - Country:US
Mailing Address - Phone:305-935-4959
Mailing Address - Fax:305-935-4960
Practice Address - Street 1:21110 BISCAYNE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1251
Practice Address - Country:US
Practice Address - Phone:305-935-4959
Practice Address - Fax:305-935-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75899207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44786OtherBLUE CROSS BLUE SHIELD
FL255681200Medicaid
FL44786OtherBLUE CROSS BLUE SHIELD