Provider Demographics
NPI:1568457521
Name:FLORIDA CARDIOLOGY GROUP LLC
Entity Type:Organization
Organization Name:FLORIDA CARDIOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALAVARYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-862-8383
Mailing Address - Street 1:PO BOX 7386
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34674-7386
Mailing Address - Country:US
Mailing Address - Phone:727-863-6573
Mailing Address - Fax:727-863-4766
Practice Address - Street 1:13740 OFFICE PARK CT STE C
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7145
Practice Address - Country:US
Practice Address - Phone:727-862-8383
Practice Address - Fax:727-863-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45934OtherBCBS
CH7618OtherRRW MCR
FL262003100Medicaid
CH7618OtherRRW MCR
FL262003100Medicaid