MEDICARE: GUSTAVO A CARDENAS MD 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	207RI0011X	Interventional Cardiology Physician	ME101884	FL
2	207RC0000X	Cardiovascular Disease Physician	ME101884	FL

General Provider Information

NPI Number	:	1245578244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUSTAVO A CARDENAS MD PA

Provider Business Mailing Address
First Line	:	9142 DUPONT PL
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6476
Country	:	US
Telephone Number	:	954-817-1445
Fax Number	:

Provider Business Practice Location Address
First Line	:	11195 S JOG RD
Second Line	:	SUITE 6
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-1829
Country	:	US
Telephone Number	:	954-817-1445
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GUSTAVO A CARDENAS
Credential	:	M.D.
Telephone Number	:	954-817-1445

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/25/2013

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