MEDICARE: GREATER FT LAUDERDALE HEART GROUP

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	80002579	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	:	1740279249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER FT LAUDERDALE HEART GROUP

Provider Business Mailing Address
First Line	:	3536 NORTH FEDERAL HWY
Second Line	:	SUITE #200
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	954-566-8367
Fax Number	:	954-566-6488

Provider Business Practice Location Address
First Line	:	3536 N FEDERAL HWY
Second Line	:	SUITE 200
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6264
Country	:	US
Telephone Number	:	954-566-8367
Fax Number	:	954-566-6488

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	PAUL L RONDINO
Credential	:	M.D
Telephone Number	:	954-785-0300

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	09/21/2009

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