MEDICARE: MAKHNI CARDIOLOGY AND MEDICAL ASSOCIATES

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	207R00000X	Internal Medicine Physician	ME49671	FL
2	207RC0000X	Cardiovascular Disease Physician	ME49678	FL

General Provider Information

NPI Number	:	1437337623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAKHNI CARDIOLOGY AND MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1700 SE HILLMOOR DR
Second Line	:	SUITE 307
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7539
Country	:	US
Telephone Number	:	772-335-3700
Fax Number	:	772-335-4006

Provider Business Practice Location Address
First Line	:	1700 SE HILLMOOR DR
Second Line	:	SUITE 307
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7539
Country	:	US
Telephone Number	:	772-335-3700
Fax Number	:	772-335-4006

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MALVINDER S MAKHNI
Credential	:	MD
Telephone Number	:	772-335-3700

Provider Enumeration Date	:	02/10/2008
Last Update Date	:	02/10/2008

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