Healthcare Provider Details

I. General information

NPI: 1689629404
Provider Name (Legal Business Name): FMC CARDIOLOGY PANEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W OAKLAND PARK BLVD EKG & ECHO READERS PANEL
LAUDERDALE LAKES FL
33313-1503
US

IV. Provider business mailing address

PO BOX 918566
ORLANDO FL
32891-8566
US

V. Phone/Fax

Practice location:
  • Phone: 954-726-1808
  • Fax: 957-726-1820
Mailing address:
  • Phone: 954-726-1808
  • Fax: 954-726-1820

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: PABLO A URBANDT
Title or Position: PRESIDENT
Credential: MD
Phone: 954-587-4112