Provider Demographics
NPI:1841287497
Name:HEART & VASCULAR CENTER OF BRADENTON, PLLC
Entity type:Organization
Organization Name:HEART & VASCULAR CENTER OF BRADENTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUBBIONDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-761-4448
Mailing Address - Street 1:6001 21ST AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7847
Mailing Address - Country:US
Mailing Address - Phone:941-761-4448
Mailing Address - Fax:941-761-0235
Practice Address - Street 1:6001 21ST AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7847
Practice Address - Country:US
Practice Address - Phone:941-761-4448
Practice Address - Fax:941-761-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261186400Medicaid
FL261186400Medicaid