Healthcare Provider Details

I. General information

NPI: 1194016006
Provider Name (Legal Business Name): TAMPA CARDIAC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE RD SUITE 205
LUTZ FL
33558-8002
US

IV. Provider business mailing address

PO BOX 18036
TAMPA FL
33679-8036
US

V. Phone/Fax

Practice location:
  • Phone: 813-229-9292
  • Fax: 813-229-9293
Mailing address:
  • Phone: 813-229-9292
  • Fax: 813-229-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN MAKATI
Title or Position: MANAGER
Credential: MD
Phone: 813-229-9292