MEDICARE: SOUTH FLORIDA PREMIERE CARDIOLOGY LLC

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	207RI0011X	Interventional Cardiology Physician	ME85982	FL

General Provider Information

NPI Number	:	1174763148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA PREMIERE CARDIOLOGY LLC

Provider Business Mailing Address
First Line	:	401 E LAS OLAS BLVD
Second Line	:	SUITE 130-137
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E LAS OLAS BLVD
Second Line	:	SUITE 130-137
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2210
Country	:	US
Telephone Number	:	954-616-3627
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENNETH ZELNICK
Credential	:	MD
Telephone Number	:	305-332-3822

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	07/16/2009

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