Provider Demographics
NPI:1306884861
Name:FLORIDA INSTITUTE FOR CARDIOVASCULAR CARE PA
Entity type:Organization
Organization Name:FLORIDA INSTITUTE FOR CARDIOVASCULAR CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-430-3866
Mailing Address - Street 1:2905 N COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3957
Mailing Address - Country:US
Mailing Address - Phone:954-967-6550
Mailing Address - Fax:954-962-3914
Practice Address - Street 1:21097 NE 27 CT
Practice Address - Street 2:SUITE 110
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1206
Practice Address - Country:US
Practice Address - Phone:305-682-8813
Practice Address - Fax:305-682-8623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21427FMedicare PIN