MEDICARE: SW FLORIDA CARDIOVASCULAR INSTITUTE 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME103088	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417332982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SW FLORIDA CARDIOVASCULAR INSTITUTE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 511446
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33951-1446
Country	:	US
Telephone Number	:	941-833-4313
Fax Number	:	941-347-8483

Provider Business Practice Location Address
First Line	:	6210 SCOTT ST
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3901
Country	:	US
Telephone Number	:	941-833-4313
Fax Number	:	941-347-8483

Authorized Official
Title or Position	:	OWNER
Name	:	GONZALO J CARRIZO
Credential	:	MD
Telephone Number	:	941-833-4313

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	11/10/2015

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