Provider Demographics
NPI:1104814714
Name:INTERVENTIONAL CARDIAC CONSULTANTS PLC
Entity type:Organization
Organization Name:INTERVENTIONAL CARDIAC CONSULTANTS PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL / MD
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KUNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-842-9486
Mailing Address - Street 1:2035 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4421
Mailing Address - Country:US
Mailing Address - Phone:727-842-9486
Mailing Address - Fax:727-849-2623
Practice Address - Street 1:2035 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4421
Practice Address - Country:US
Practice Address - Phone:727-842-9486
Practice Address - Fax:727-849-2623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
40897OtherBLUE CROSS BLUE SHIELD
FL260351900Medicaid
40897OtherBLUE CROSS BLUE SHIELD