Healthcare Provider Details

I. General information

NPI: 1982930566
Provider Name (Legal Business Name): FRED APPELKVIST ARDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SW 57TH AVE SUITE 206
MIAMI FL
33155-2163
US

IV. Provider business mailing address

1700 SW 57TH AVE SUITE 206
MIAMI FL
33155-2163
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-9051
  • Fax: 305-267-8884
Mailing address:
  • Phone: 305-266-9051
  • Fax: 305-267-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number59694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: