Provider Demographics
NPI:1861618753
Name:CENTRAL FLORIDA HEART ASSOCIATES PA
Entity type:Organization
Organization Name:CENTRAL FLORIDA HEART ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:GOVIND
Authorized Official - Last Name:HIPPALGAONKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-774-2100
Mailing Address - Street 1:932 SAXON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8313
Mailing Address - Country:US
Mailing Address - Phone:386-774-2100
Mailing Address - Fax:386-774-0326
Practice Address - Street 1:932 SAXON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8313
Practice Address - Country:US
Practice Address - Phone:386-774-2100
Practice Address - Fax:386-774-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME046947207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24669Medicare ID - Type Unspecified