=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043302102
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA HEART & VASCULAR ASSOCIATES, PL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 02/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 MEDICAL PARK DR SUITE 500
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33613-4680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-971-2424
-----------------------------------------------------
Fax | 813-972-9575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 MEDICAL PARK DR SUITE 500
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33613-4680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-971-2424
-----------------------------------------------------
Fax | 813-972-9575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KEVIN L KLEIN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 813-971-2424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------