MEDICARE: CARDIOVASCULAR CLINIC OF ORLANDO PLLC

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1225377526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR CLINIC OF ORLANDO PLLC

Provider Business Mailing Address
First Line	:	400 S ORLANDO AVE
Second Line	:	SUITE 205
City	:	MAITLAND
State	:	FL
Zip	:	32751-5644
Country	:	US
Telephone Number	:	407-392-2252
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S ORLANDO AVE
Second Line	:	SUITE 205
City	:	MAITLAND
State	:	FL
Zip	:	32751-5644
Country	:	US
Telephone Number	:	407-392-2252
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	AMITRA CAINES
Credential	:	MD
Telephone Number	:	407-392-2252

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	07/07/2014

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