Healthcare Provider Details

I. General information

NPI: 1871613620
Provider Name (Legal Business Name): CARLO M ZEIDENWEBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 CENTRAL PARK BLVD N STE 318
BOCA RATON FL
33428-1704
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146
US

V. Phone/Fax

Practice location:
  • Phone: 561-558-1212
  • Fax:
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number12184
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME92495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: