Provider Demographics
NPI:1306329370
Name:ADVANCED CARDIOVASCULAR CONSULTANTS LLC
Entity type:Organization
Organization Name:ADVANCED CARDIOVASCULAR CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHANTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-313-7743
Mailing Address - Street 1:5305 GREENWOOD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2449
Mailing Address - Country:US
Mailing Address - Phone:561-882-6060
Mailing Address - Fax:561-845-2297
Practice Address - Street 1:5305 GREENWOOD AVE STE 204
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2449
Practice Address - Country:US
Practice Address - Phone:561-882-6060
Practice Address - Fax:561-845-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty