Basic Information
| Provider Information | |||||||||
| NPI: | 1568457521 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA CARDIOLOGY GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7386 | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346747386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278636573 | ||||||||
| FaxNumber: | 7278634766 | ||||||||
| Practice Location | |||||||||
| Address1: | 13740 OFFICE PARK CT STE C | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346677145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278628383 | ||||||||
| FaxNumber: | 7278634766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHALAVARYA | ||||||||
| AuthorizedOfficialFirstName: | GOPAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7278628383 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 45934 | 01 | FL | BCBS | OTHER | CH7618 | 01 | RRW MCR | OTHER | 262003100 | 05 | FL | MEDICAID |