MEDICARE: CARLO M ZEIDENWEBER MD

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	2080P0202X	Pediatric Cardiology Physician	12184	NV
2	2080P0202X	Pediatric Cardiology Physician	ME92495	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	NV8269	OTHER	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871613620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLO M ZEIDENWEBER MD

Provider Business Mailing Address
First Line	:	5955 PONCE DE LEON BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146
Country	:	US
Telephone Number	:	305-661-1515
Fax Number	:	305-662-3723

Provider Business Practice Location Address
First Line	:	9980 CENTRAL PARK BLVD N STE 318
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1704
Country	:	US
Telephone Number	:	561-558-1212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	09/30/2021

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Directions to “ CARLO M ZEIDENWEBER MD” Practice Location

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