Provider Demographics
NPI:1710994389
Name:INTRACOASTAL CARDIOTHORACIC SURGERY, LLC
Entity Type:Organization
Organization Name:INTRACOASTAL CARDIOTHORACIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:HEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-694-6911
Mailing Address - Street 1:3370 BURNS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4327
Mailing Address - Country:US
Mailing Address - Phone:561-694-6911
Mailing Address - Fax:561-625-3239
Practice Address - Street 1:3370 BURNS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4327
Practice Address - Country:US
Practice Address - Phone:561-694-6911
Practice Address - Fax:561-625-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty