=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851348031
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVENTURA CARDIOVASCULAR SURGEONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 08/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21097 NE 27TH CT SUITE 370
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-935-9883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21097 NE 27TH CT SUITE 370
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-935-9883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | GARY DUNCAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-935-9883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------