Healthcare Provider Details

I. General information

NPI: 1326364076
Provider Name (Legal Business Name): SOUTH FLORIDA INTERVENTIONAL RADIOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD SUITE 740
MIAMI BEACH FL
33140-4556
US

IV. Provider business mailing address

PO BOX 63225
CHARLOTTE NC
28263-3225
US

V. Phone/Fax

Practice location:
  • Phone: 305-855-0306
  • Fax:
Mailing address:
  • Phone: 305-855-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME76154
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME76154
License Number StateFL

VIII. Authorized Official

Name: MICHAEL ROGOFF
Title or Position: DIRECTOR
Credential: MD
Phone: 305-855-0306