Healthcare Provider Details

I. General information

NPI: 1811931629
Provider Name (Legal Business Name): INTERVENTIONAL CARDIOLOGISTS OF GAINESVILLE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NW 8TH AVE
GAINESVILLE FL
32605
US

IV. Provider business mailing address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4524
US

V. Phone/Fax

Practice location:
  • Phone: 352-264-2500
  • Fax: 352-331-9095
Mailing address:
  • Phone: 352-264-2500
  • Fax: 352-331-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY WESSEL
Title or Position: PRESIDENT
Credential: MD
Phone: 352-375-1212