Provider Demographics
NPI:1144528886
Name:HEART AND VASCULAR CARE OF SOUTH FLORIDA
Entity type:Organization
Organization Name:HEART AND VASCULAR CARE OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAQAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-424-5555
Mailing Address - Street 1:1395 S STATE ROAD 7
Mailing Address - Street 2:#400
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9325
Mailing Address - Country:US
Mailing Address - Phone:561-424-5555
Mailing Address - Fax:561-425-5550
Practice Address - Street 1:1395 S STATE ROAD 7
Practice Address - Street 2:#400
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9325
Practice Address - Country:US
Practice Address - Phone:561-424-5555
Practice Address - Fax:561-425-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103790207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8459K0Medicare PIN
FLF42627Medicare UPIN