Provider Demographics
NPI:1871613620
Name:ZEIDENWEBER, CARLO M (MD)
Entity type:Individual
Prefix:
First Name:CARLO
Middle Name:M
Last Name:ZEIDENWEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-661-1515
Mailing Address - Fax:305-662-3723
Practice Address - Street 1:9980 CENTRAL PARK BLVD N STE 318
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1704
Practice Address - Country:US
Practice Address - Phone:561-558-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV121842080P0202X
FLME924952080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8269OtherBLUE CROSS BLUE SHIELD
NV100512250Medicaid
104362Medicare PIN