Provider Demographics
NPI:1174174239
Name:PALM BEACH HEART & VASCULAR, LLC
Entity type:Organization
Organization Name:PALM BEACH HEART & VASCULAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-500-5347
Mailing Address - Street 1:2609 W WOOLBRIGHT RD STE 4
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6634
Mailing Address - Country:US
Mailing Address - Phone:561-500-5347
Mailing Address - Fax:561-264-5347
Practice Address - Street 1:2609 W WOOLBRIGHT RD STE 4
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6634
Practice Address - Country:US
Practice Address - Phone:561-500-5347
Practice Address - Fax:561-264-5347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015021200Medicaid