MEDICARE: ANELEY HUNDAE PORT CHARLOTTE 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	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME106485	OTHER	FL	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417424482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANELEY HUNDAE PORT CHARLOTTE CARDIOLOGY LLC

Provider Business Mailing Address
First Line	:	3161 HARBOR BLVD STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6754
Country	:	US
Telephone Number	:	941-235-8892
Fax Number	:	941-883-4494

Provider Business Practice Location Address
First Line	:	3161 HARBOR BLVD STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6754
Country	:	US
Telephone Number	:	941-235-8892
Fax Number	:	941-883-4494

Authorized Official
Title or Position	:	OWNER
Name	:	ANELEY Y HUNDAE
Credential	:	MD
Telephone Number	:	941-235-8892

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	01/22/2019

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