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General NPI Number Information
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NPI Number | 1992191910
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Entity Type | Organization
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Legal Business Name | ATLANTIC HEART AND VASCULAR SPECIALISTS, INC
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 11512 LAKE MEAD AVE STE 303
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9680
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Country | US
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Telephone | 904-296-9933
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Fax | 904-930-4175
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Provider Business Mailing Address
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Address Line | PO BOX 551107
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City | JACKSONVILLE
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State | FL
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Zip | 32255-1107
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Country | US
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Telephone | 904-296-9933
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Fax | 904-930-4175
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Authorized Official
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Title or Position | PRESIDENT
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Name | KHAWAR M SHAIKH
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Credential | M.D.
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Telephone | 904-296-9933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME114219
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License Number State | FL
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