Provider Demographics
NPI:1548202724
Name:SOUTH FLORIDA CARDIOLOGY GROUP INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA CARDIOLOGY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-261-6855
Mailing Address - Street 1:PO BOX 166279
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-6279
Mailing Address - Country:US
Mailing Address - Phone:305-380-1626
Mailing Address - Fax:305-386-1635
Practice Address - Street 1:5200 SW 8TH ST
Practice Address - Street 2:SUITE 204B
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2300
Practice Address - Country:US
Practice Address - Phone:305-261-6855
Practice Address - Fax:305-261-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 7385207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40537OtherMEDICARE PROVIDER ID