Basic Information
| Provider Information | |||||||||
| NPI: | 1205465440 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOLOGY GROUP PANEL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 499 NW 70TH AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333177500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547261808 | ||||||||
| FaxNumber: | 9547261820 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 NW 82ND AVE STE 405 | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333241883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545874112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2020 | ||||||||
| LastUpdateDate: | 04/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | URBANDT | ||||||||
| AuthorizedOfficialFirstName: | PABLO | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9545874112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.