Healthcare Provider Details

I. General information

NPI: 1336103100
Provider Name (Legal Business Name): FLORIDA HEART SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N FLAMINGO RD SUITE 150
PEMBROKE PINES FL
33028-1023
US

IV. Provider business mailing address

603 N FLAMINGO RD SUITE 150
PEMBROKE PINES FL
33028-1023
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-6660
  • Fax: 954-436-6655
Mailing address:
  • Phone: 954-436-6660
  • Fax: 954-436-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MIAN A HASAN
Title or Position: MD
Credential: M.D
Phone: 954-436-6660