Provider Demographics
NPI:1972589539
Name:RICK FRAGA MD PA
Entity Type:Organization
Organization Name:RICK FRAGA MD PA
Other - Org Name:CARDIOTHORACIC PARTNERS OF MIAMI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:Z
Authorized Official - Last Name:FRAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-273-5511
Mailing Address - Street 1:11400 N KENDALL DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1029
Mailing Address - Country:US
Mailing Address - Phone:305-273-5511
Mailing Address - Fax:305-273-6622
Practice Address - Street 1:11400 N. KENDALL DRIVE
Practice Address - Street 2:SUITE 214
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-273-5511
Practice Address - Fax:305-273-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046427174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251369200Medicaid
FL251369200Medicaid