Provider Demographics
NPI:1265698203
Name:HEARTWELL LLP
Entity type:Organization
Organization Name:HEARTWELL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALKOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-200-0399
Mailing Address - Street 1:7990 SW 117TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3847
Mailing Address - Country:US
Mailing Address - Phone:305-200-0399
Mailing Address - Fax:786-347-8813
Practice Address - Street 1:7990 SW 117TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3847
Practice Address - Country:US
Practice Address - Phone:305-200-0399
Practice Address - Fax:786-347-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008564400Medicaid
FLBP174Medicare PIN