Healthcare Provider Details

I. General information

NPI: 1841287497
Provider Name (Legal Business Name): HEART & VASCULAR CENTER OF BRADENTON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 21ST AVE W
BRADENTON FL
34209-7847
US

IV. Provider business mailing address

6001 21ST AVE W
BRADENTON FL
34209-7847
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-4448
  • Fax: 941-761-0235
Mailing address:
  • Phone: 941-761-4448
  • Fax: 941-761-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT J SUBBIONDO
Title or Position: OWNER/MANAGING PARTNER
Credential: MD
Phone: 941-761-4448