Basic Information
| Provider Information | |||||||||
| NPI: | 1790446516 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MSMC INTERVENTIONAL, LLC | ||||||||
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| Address1: | PO BOX 10550 | ||||||||
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| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331010550 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2845 AVENTURA BLVD | ||||||||
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| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331803118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056827360 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2022 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHUTKAN | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3056742121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.