Provider Demographics
NPI:1558557918
Name:INSTITUTE FOR CARDIOVASCULAR DISEASE PA
Entity Type:Organization
Organization Name:INSTITUTE FOR CARDIOVASCULAR DISEASE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ADALBERTO
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC,FACP
Authorized Official - Phone:305-558-3300
Mailing Address - Street 1:2301 NW 87TH AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2403
Mailing Address - Country:US
Mailing Address - Phone:305-558-3300
Mailing Address - Fax:305-558-5775
Practice Address - Street 1:2301 NW 87TH AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2403
Practice Address - Country:US
Practice Address - Phone:305-558-3300
Practice Address - Fax:305-558-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL53375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL245Medicare PIN