Provider Demographics
NPI:1568499937
Name:CARDIAC SURGICAL ASSOCIATES OF SOUTHWEST FLORIDA, M.D., P.A.
Entity Type:Organization
Organization Name:CARDIAC SURGICAL ASSOCIATES OF SOUTHWEST FLORIDA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-939-1767
Mailing Address - Street 1:8010 SUMMERLIN LAKES DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1849
Mailing Address - Country:US
Mailing Address - Phone:239-939-1767
Mailing Address - Fax:239-939-5895
Practice Address - Street 1:8010 SUMMERLIN LAKES DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1849
Practice Address - Country:US
Practice Address - Phone:239-939-1767
Practice Address - Fax:239-939-5895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99256Medicare ID - Type Unspecified