Organization
FLORIDA HEART & VASCULAR CARE, PLLC
Active
Organization
FLORIDA HEART & VASCULAR CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAREN CHRISTIANE THEILADE M.D. (EXECUTIVE DIRECTOR)
(386) 237-7353
Entity
Organization
Contact information
Practice address
120 CYPRESS EDGE DR, SUITE 203, PALM COAST, FL 32164-8453
(386) 586-4410
Mailing address
146 PALM COAST RESORT BLVD, SUITE 806, PALM COAST, FL 32137-1812
(615) 400-0380
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0046G
BCBS
FL
05
—
008378300
—
FL
01
—
DT6579
RAILROAD
FL
Enumeration date
01/18/2013
Last updated
09/30/2013
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