Provider Demographics
NPI:1316122633
Name:CARDIAC CONSULTANTS PA
Entity type:Organization
Organization Name:CARDIAC CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-334-4448
Mailing Address - Street 1:201 N PARK AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4147
Mailing Address - Country:US
Mailing Address - Phone:407-334-4448
Mailing Address - Fax:407-889-1903
Practice Address - Street 1:201 N PARK AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4147
Practice Address - Country:US
Practice Address - Phone:407-334-4448
Practice Address - Fax:407-889-1903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-05
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85102207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8550OtherINDIVIDUAL MC PROVIDER #
FL264285900Medicaid
FL1770571846OtherINDIVIDUAL PROVIDER NPI #
FLE8550OtherINDIVIDUAL MC PROVIDER #