Basic Information
| Provider Information | |||||||||
| NPI: | 1023419991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERVENTIONAL RADIOLOGY SPECIALISTS OF MIAMI INC | ||||||||
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| Address1: | 1190 NW 95TH ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331502063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059043490 | ||||||||
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| Address1: | 1190 NW 95TH ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331502063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059043490 | ||||||||
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| ProviderEnumerationDate: | 09/10/2014 | ||||||||
| LastUpdateDate: | 09/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | MOND | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGISTERED AGENT | ||||||||
| AuthorizedOfficialTelephone: | 3059043490 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | ME69880 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.