MEDICARE: CARDIO THORACIC SURGICAL INSTITUTE OF SOUTH FLORIDA, LLLP

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	:	1851691950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIO THORACIC SURGICAL INSTITUTE OF SOUTH FLORIDA, LLLP

Provider Business Mailing Address
First Line	:	5601 N DIXIE HWY
Second Line	:	SUITE 209
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33334-4145
Country	:	US
Telephone Number	:	954-942-7083
Fax Number	:	954-491-2628

Provider Business Practice Location Address
First Line	:	5601 N DIXIE HWY
Second Line	:	SUITE 209
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33334-4145
Country	:	US
Telephone Number	:	954-942-7083
Fax Number	:	954-491-2628

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. IRVING B DAVID
Credential	:	M.D.
Telephone Number	:	954-942-7083

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	10/25/2010

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