MEDICARE: CARDIOLOGY CONSULTANTS

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471R0002X	Radiation Therapy Radiologic Technologist	3516-3	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	99507	OTHER	FL	BLUE CROSS GROUP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1548479579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOLOGY CONSULTANTS

Provider Business Mailing Address
First Line	:	2320 N ORANGE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5506
Country	:	US
Telephone Number	:	407-896-0054
Fax Number	:	407-898-4463

Provider Business Practice Location Address
First Line	:	2320 N ORANGE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5506
Country	:	US
Telephone Number	:	407-896-0054
Fax Number	:	407-898-4463

Authorized Official
Title or Position	:	CEO
Name	:	DR. JAMES L BOLEN
Credential	:	M.D.
Telephone Number	:	407-896-0054

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	11/17/2009

2320 N ORANGE AVE , SUITE 201
ORLANDO, FL
32804-5506

Practice Phone: 407-896-7111
Practice Fax: 407-894-4018