Healthcare Provider Details

I. General information

NPI: 1497717565
Provider Name (Legal Business Name): LOUIS CARNENDRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 NW 95TH ST STE 404
MIAMI FL
33150-2063
US

IV. Provider business mailing address

1190 NW 95TH ST STE 404
MIAMI FL
33150-2063
US

V. Phone/Fax

Practice location:
  • Phone: 305-932-2463
  • Fax: 305-694-4827
Mailing address:
  • Phone: 305-932-2463
  • Fax: 305-694-4827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME92574
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME92574
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberME92574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: