Provider Demographics
NPI:1952325490
Name:INSTITUTE OF CARDIOVASCULAR MEDICINE LLC
Entity Type:Organization
Organization Name:INSTITUTE OF CARDIOVASCULAR MEDICINE LLC
Other - Org Name:CENTRAL FLORIDA HEART CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-291-0166
Mailing Address - Street 1:PO BOX 919298
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9298
Mailing Address - Country:US
Mailing Address - Phone:352-624-7384
Mailing Address - Fax:352-624-7385
Practice Address - Street 1:10435 SE 170TH PL
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8998
Practice Address - Country:US
Practice Address - Phone:352-347-7923
Practice Address - Fax:352-347-6181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40773OtherBCBS
FL262215700Medicaid
FLCD5197OtherRR MEDICARE
FL262215700Medicaid
FL40773OtherBCBS