Healthcare Provider Details

I. General information

NPI: 1023419991
Provider Name (Legal Business Name): INTERVENTIONAL RADIOLOGY SPECIALISTS OF MIAMI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 NW 95TH ST SUITE 301
MIAMI FL
33150-2063
US

IV. Provider business mailing address

1190 NW 95TH ST SUITE 301
MIAMI FL
33150-2063
US

V. Phone/Fax

Practice location:
  • Phone: 305-904-3490
  • Fax:
Mailing address:
  • Phone: 305-904-3490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME69880
License Number StateFL

VIII. Authorized Official

Name: DAVID MOND
Title or Position: REGISTERED AGENT
Credential:
Phone: 305-904-3490