Healthcare Provider Details

I. General information

NPI: 1346791498
Provider Name (Legal Business Name): ANSAARIE CARDIAC & ENDOVASCULAR CENTER OF EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HWY 17S
EAST PALATKA FL
32131-4087
US

IV. Provider business mailing address

209 PINEHURST POINTE DR
ST AUGUSTINE FL
32092-3703
US

V. Phone/Fax

Practice location:
  • Phone: 386-232-9203
  • Fax: 386-222-3064
Mailing address:
  • Phone: 386-232-9203
  • Fax: 386-222-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME121178
License Number StateFL

VIII. Authorized Official

Name: IMRAN ANSAARIE
Title or Position: OWNER
Credential: M.D
Phone: 386-232-9203