Provider Demographics
NPI:1972606440
Name:CARDIOLOGY ASSOC OF PALM BEACH
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOC OF PALM BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:KACHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-478-1104
Mailing Address - Street 1:1401 FORUM WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-478-1104
Mailing Address - Fax:561-478-9505
Practice Address - Street 1:1401 FORUM WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-478-1104
Practice Address - Fax:561-478-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267013500Medicaid
FL99673Medicare PIN