Provider Demographics
NPI:1386896173
Name:LAKE WORTH CARDIOLOGY CONSULTANTS LLC
Entity type:Organization
Organization Name:LAKE WORTH CARDIOLOGY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-972-9712
Mailing Address - Street 1:4849 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3455
Mailing Address - Country:US
Mailing Address - Phone:561-202-6064
Mailing Address - Fax:561-202-6089
Practice Address - Street 1:4849 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3455
Practice Address - Country:US
Practice Address - Phone:561-433-4446
Practice Address - Fax:561-433-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1336161603OtherNATIONAL PROVIDER ID
FL1336161603OtherNATIONAL PROVIDER ID