Provider Demographics
NPI:1841479987
Name:CARDIOLOGY ON CALL PA
Entity type:Organization
Organization Name:CARDIOLOGY ON CALL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LONDONO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-531-6967
Mailing Address - Street 1:PO BOX 402647
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140
Mailing Address - Country:US
Mailing Address - Phone:305-531-6967
Mailing Address - Fax:305-531-7622
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:#2050
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140
Practice Address - Country:US
Practice Address - Phone:305-531-6967
Practice Address - Fax:305-531-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77073208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255679100Medicaid
FLE1815Medicare PIN