Provider Demographics
NPI:1699173625
Name:CARDIOVASCULAR CONSULTANTS OF SOUTH BROWARDPLLC
Entity type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS OF SOUTH BROWARDPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-842-2577
Mailing Address - Street 1:1150 N 35TH AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5424
Mailing Address - Country:US
Mailing Address - Phone:954-842-2577
Mailing Address - Fax:954-944-1377
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-842-2577
Practice Address - Fax:954-944-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55397207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty