MEDICARE: INSTITUTE FOR THORACIC SURGERY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME81351	FL

General Provider Information

NPI Number	:	1124233325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR THORACIC SURGERY PA

Provider Business Mailing Address
First Line	:	6201 SW 70TH ST
Second Line	:	SUITE 104
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4718
Country	:	US
Telephone Number	:	305-663-5864
Fax Number	:	305-663-9778

Provider Business Practice Location Address
First Line	:	6201 SW 70TH ST
Second Line	:	SUITE 104
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4718
Country	:	US
Telephone Number	:	305-663-5864
Fax Number	:	305-663-9778

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK RICHARD DYLEWSKI
Credential	:	M.D.
Telephone Number	:	305-663-5864

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	03/19/2008

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