Provider Demographics
NPI:1669785705
Name:CARDIOVASCULAR SERVICES LLC
Entity type:Organization
Organization Name:CARDIOVASCULAR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ABADIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-419-6537
Mailing Address - Street 1:212 S PINE AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4838
Mailing Address - Country:US
Mailing Address - Phone:352-419-6537
Mailing Address - Fax:352-419-6541
Practice Address - Street 1:212 S PINE AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4838
Practice Address - Country:US
Practice Address - Phone:352-419-6537
Practice Address - Fax:352-419-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59443207RC0000X
207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055078700Medicaid
FL055078700Medicaid