MEDICARE: MIAMI CARDIOVASCULAR SERVICES 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	207RC0000X	Cardiovascular Disease Physician	ME 49087	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME 49087	OTHER	FL	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1821237892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI CARDIOVASCULAR SERVICES LLC

Provider Business Mailing Address
First Line	:	3181 CORAL WAY
Second Line	:	6TH FLOOR
City	:	MIAMI
State	:	FL
Zip	:	33145
Country	:	US
Telephone Number	:	786-497-2710
Fax Number	:

Provider Business Practice Location Address
First Line	:	3181 CORAL WAY
Second Line	:	6TH FLOOR
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3216
Country	:	US
Telephone Number	:	786-497-2710
Fax Number	:	786-497-2711

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ILDEFONSO JOSE MAS
Credential	:	MD
Telephone Number	:	786-497-2710

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	02/24/2009

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