Healthcare Provider Details

I. General information

NPI: 1669604005
Provider Name (Legal Business Name): URBAN CARDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SE 17TH STREET SUITE 700
OCALA FL
34471-4191
US

IV. Provider business mailing address

PO BOX 850001 DEPT 0673
ORLANDO FL
32885-0673
US

V. Phone/Fax

Practice location:
  • Phone: 352-861-5634
  • Fax: 352-387-0382
Mailing address:
  • Phone: 352-861-5634
  • Fax: 352-387-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9184663
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME42058
License Number StateFL

VIII. Authorized Official

Name: PAUL URBAN
Title or Position: OWNER
Credential: MD
Phone: 352-861-5634