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NPI Code Detail

MEDICARE: LAKE WORTH CARDIOLOGY CONSULTANTS LLC

MEDICARE: LAKE WORTH CARDIOLOGY CONSULTANTS 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
1174400000XSpecialistME102740FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11336161603OTHERFLNATIONAL PROVIDER ID

General Provider Information

NPI Number : 1386896173
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE WORTH CARDIOLOGY CONSULTANTS LLC
Provider Business Mailing Address
First Line : 4849 LAKE WORTH RD
Second Line :
City : GREENACRES
State : FL
Zip : 33463-3455
Country : US
Telephone Number : 561-202-6064
Fax Number : 561-202-6089
Provider Business Practice Location Address
First Line : 4849 LAKE WORTH RD
Second Line :
City : GREENACRES
State : FL
Zip : 33463-3455
Country : US
Telephone Number : 561-433-4446
Fax Number : 561-433-3026
Authorized Official
Title or Position : MANAGER
Name : MRS. ADELINE ETIENNE
Credential :
Telephone Number : 718-972-9712
Provider Enumeration Date : 10/13/2008
Last Update Date : 03/28/2009

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Directions to “LAKE WORTH CARDIOLOGY CONSULTANTS LLC ” Practice Location

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