Provider Demographics
NPI:1154030617
Name:SOUTH FLORIDA HEART & VASCULAR
Entity type:Organization
Organization Name:SOUTH FLORIDA HEART & VASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEMANG
Authorized Official - Middle Name:BHADRESHKUMAR
Authorized Official - Last Name:PANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-429-0130
Mailing Address - Street 1:6231 PGA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4033
Mailing Address - Country:US
Mailing Address - Phone:423-429-0130
Mailing Address - Fax:
Practice Address - Street 1:4425 MILITARY TRL STE 102
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4816
Practice Address - Country:US
Practice Address - Phone:423-429-0130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty