Provider Demographics
NPI:1568415693
Name:SOUTH BEACH PREVENTIVE CARDIOLOGY PA
Entity Type:Organization
Organization Name:SOUTH BEACH PREVENTIVE CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:AGATSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-538-3828
Mailing Address - Street 1:1691 MICHIGAN AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2520
Mailing Address - Country:US
Mailing Address - Phone:305-538-3828
Mailing Address - Fax:305-538-1979
Practice Address - Street 1:1691 MICHIGAN AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2520
Practice Address - Country:US
Practice Address - Phone:305-538-3828
Practice Address - Fax:305-538-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5077207Q00000X
FLME34856207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6497Medicare ID - Type UnspecifiedMEDICARE