Provider Demographics
NPI:1215267497
Name:CARDIOVASCULAR INSTITUTE OF ORLANDO, PLLC
Entity type:Organization
Organization Name:CARDIOVASCULAR INSTITUTE OF ORLANDO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUVARCHALA
Authorized Official - Middle Name:DEVI
Authorized Official - Last Name:DARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-480-4445
Mailing Address - Street 1:PO BOX 781729
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32878-1729
Mailing Address - Country:US
Mailing Address - Phone:407-480-4445
Mailing Address - Fax:407-480-4446
Practice Address - Street 1:1111 S SEMORAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1480
Practice Address - Country:US
Practice Address - Phone:407-480-4445
Practice Address - Fax:407-480-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105611207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA12342Medicare UPIN