=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841428919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDS CARDIAC CENTER PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2009
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20818 W DIXIE HWY
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-933-3035
-----------------------------------------------------
Fax | 305-933-8035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20818 W DIXIE HWY
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-933-3035
-----------------------------------------------------
Fax | 305-933-8035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JACK WILLIAM BANDEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-282-6063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0202X
-----------------------------------------------------
Taxonomy Name | Pediatric Cardiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------