Provider Demographics
NPI:1588680797
Name:CARDIOCARE OF SOUTH FLORIDA PA
Entity Type:Organization
Organization Name:CARDIOCARE OF SOUTH FLORIDA PA
Other - Org Name:ERIC M SPIVACK MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPIVACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-692-9299
Mailing Address - Street 1:21110 BISCAYNE BLVD
Mailing Address - Street 2:#208
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-692-9299
Mailing Address - Fax:305-692-8668
Practice Address - Street 1:21110 BISCAYNE BLVD
Practice Address - Street 2:#208
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-692-9299
Practice Address - Fax:305-692-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047753200Medicaid
FLGA805AMedicare Oscar/Certification