Basic Information
| Provider Information | |||||||||
| NPI: | 1255392767 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-FLORIDA CARDIOLOGY SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 S ORANGE AVENUE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073515384 | ||||||||
| FaxNumber: | 4078727436 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 S ORANGE AVENUE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073515384 | ||||||||
| FaxNumber: | 4078727436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2006 | ||||||||
| LastUpdateDate: | 03/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | HAZDAY | ||||||||
| AuthorizedOfficialFirstName: | MARCOS | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4073515384 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.