MEDICARE: CHARLESTON CARDIAC SURGERY ASS

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1770080327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON CARDIAC SURGERY ASS

Provider Business Mailing Address
First Line	:	2655 COLLINS AVE APT 1611
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-4718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3270 NW 36TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-5036
Country	:	US
Telephone Number	:	815-621-6182
Fax Number	:	305-634-4522

Authorized Official
Title or Position	:	SURGEON
Name	:	RAKESH WAHI
Credential	:	MD
Telephone Number	:	815-621-6182

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/10/2018

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