MEDICARE: CARDIOVASCULAR CONSULTANTS GROUP LLC

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	ME95512	FL

General Provider Information

NPI Number	:	1568600930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR CONSULTANTS GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 690656
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32869-0656
Country	:	US
Telephone Number	:	407-749-2289
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 HILLSDALE LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7561
Country	:	US
Telephone Number	:	407-201-4490
Fax Number	:

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	IMRAN BAWANEY
Credential	:
Telephone Number	:	407-749-2289

Provider Enumeration Date	:	01/23/2009
Last Update Date	:	09/30/2018

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