Healthcare Provider Details

I. General information

NPI: 1104814714
Provider Name (Legal Business Name): INTERVENTIONAL CARDIAC CONSULTANTS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 LITTLE RD
TRINITY FL
34655-4421
US

IV. Provider business mailing address

2035 LITTLE RD
TRINITY FL
34655-4421
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-9486
  • Fax: 727-849-2623
Mailing address:
  • Phone: 727-842-9486
  • Fax: 727-849-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: RENE E KUNHARDT
Title or Position: AUTHORIZED OFFICIAL / MD
Credential: MD
Phone: 727-842-9486