MEDICARE: CARDIOVASCULAR ADVANTAGES OF FLORIDA, 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1700329216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR ADVANTAGES OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 87159
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70879-8159
Country	:	US
Telephone Number	:	407-446-8755
Fax Number	:	877-885-9540

Provider Business Practice Location Address
First Line	:	4767 NEW BROAD ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6405
Country	:	US
Telephone Number	:	407-446-8722
Fax Number	:	877-885-9540

Authorized Official
Title or Position	:	AMBR, COO
Name	:	MR. LAWRENCE S LIEBERMAN
Credential	:
Telephone Number	:	407-446-8755

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	12/01/2016

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