Provider Demographics
NPI:1619952223
Name:AVENTURA HEART CENTER, LLC
Entity Type:Organization
Organization Name:AVENTURA HEART CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-932-6061
Mailing Address - Street 1:2845 AVENTURA BLVD
Mailing Address - Street 2:STE 249
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3118
Mailing Address - Country:US
Mailing Address - Phone:305-932-6061
Mailing Address - Fax:305-932-6717
Practice Address - Street 1:2845 AVENTURA BLVD
Practice Address - Street 2:STE 249
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3118
Practice Address - Country:US
Practice Address - Phone:305-932-6061
Practice Address - Fax:305-932-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258125600Medicaid
FL258125600Medicaid