Provider Demographics
NPI:1649234626
Name:CENTRAL FLORIDA CARDIOVASCULAR CENTER PA
Entity Type:Organization
Organization Name:CENTRAL FLORIDA CARDIOVASCULAR CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN- PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAYENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-253-0003
Mailing Address - Street 1:1691 MAYO DR.
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778
Mailing Address - Country:US
Mailing Address - Phone:352-253-0003
Mailing Address - Fax:352-253-0016
Practice Address - Street 1:1691 MAYO DR.
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778
Practice Address - Country:US
Practice Address - Phone:352-253-0003
Practice Address - Fax:352-253-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371254100Medicaid
FL371254100Medicaid
FLF35840Medicare UPIN