Provider Demographics
NPI: | 1942511712 |
---|---|
Name: | HEART CARE PL |
Entity Type: | Organization |
Organization Name: | HEART CARE PL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MUHAMMAD |
Authorized Official - Middle Name: | IRFAN |
Authorized Official - Last Name: | ASLAM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 321-794-7466 |
Mailing Address - Street 1: | 7777 N WICKJHAM RD |
Mailing Address - Street 2: | S |
Mailing Address - City: | MELBOURNE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32940 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 321-794-7466 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1091 PORT MALABAR BLVD NE |
Practice Address - Street 2: | SUITE |
Practice Address - City: | PALM BAY |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32905-5100 |
Practice Address - Country: | US |
Practice Address - Phone: | 321-794-7466 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-06-28 |
Last Update Date: | 2010-06-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME101181 | 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Single Specialty |