Healthcare Provider Details

I. General information

NPI: 1720108210
Provider Name (Legal Business Name): TREASURE COAST CARDIOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 HWY 441 N SUITE B
OKEECHOBEE FL
34972
US

IV. Provider business mailing address

1713 HWY 441 N SUITE B
OKEECHOBEE FL
34972
US

V. Phone/Fax

Practice location:
  • Phone: 863-467-9400
  • Fax: 863-467-8708
Mailing address:
  • Phone: 863-467-9400
  • Fax: 863-467-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME70365
License Number StateFL

VIII. Authorized Official

Name: SHAKOOR A. ARAIN
Title or Position: PRESIDENT
Credential: MD
Phone: 863-467-9400