Provider Demographics
NPI:1689629404
Name:FMC CARDIOLOGY PANEL LLC
Entity Type:Organization
Organization Name:FMC CARDIOLOGY PANEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:A
Authorized Official - Last Name:URBANDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-587-4112
Mailing Address - Street 1:PO BOX 918566
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8566
Mailing Address - Country:US
Mailing Address - Phone:954-726-1808
Mailing Address - Fax:954-726-1820
Practice Address - Street 1:5000 W OAKLAND PARK BLVD
Practice Address - Street 2:EKG & ECHO READERS PANEL
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1503
Practice Address - Country:US
Practice Address - Phone:954-726-1808
Practice Address - Fax:957-726-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
45986OtherBLUE CROSS/BLUE SHIELD
FLK2367Medicare PIN