MEDICARE: CARDIOVASCULAR INSTITUTE OF AMERICA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104291178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR INSTITUTE OF AMERICA PA

Provider Business Mailing Address
First Line	:	6328 GUNN HWY STE C
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4101
Country	:	US
Telephone Number	:	813-610-9510
Fax Number	:

Provider Business Practice Location Address
First Line	:	6328 GUNN HWY STE C
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4101
Country	:	US
Telephone Number	:	813-610-9510
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MUTHUSAMY VELUSAMY
Credential	:
Telephone Number	:	813-610-9510

Provider Enumeration Date	:	12/02/2015
Last Update Date	:	07/23/2020

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Directions to “CARDIOVASCULAR INSTITUTE OF AMERICA PA ” Practice Location

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