Provider Demographics
NPI:1669954707
Name:CARDIOVASCULAR SURGICAL SUITES LLC
Entity type:Organization
Organization Name:CARDIOVASCULAR SURGICAL SUITES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-510-9560
Mailing Address - Street 1:825 CORAL RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4180
Mailing Address - Country:US
Mailing Address - Phone:954-510-9560
Mailing Address - Fax:954-510-9565
Practice Address - Street 1:825 CORAL RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4180
Practice Address - Country:US
Practice Address - Phone:954-510-9560
Practice Address - Fax:954-510-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical