Healthcare Provider Details

I. General information

NPI: 1124085014
Provider Name (Legal Business Name): VIJAYKUMAR C AMIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 SIDERWHEEL DR
ROCKLEDGE FL
32955-6026
US

IV. Provider business mailing address

3322 SIDERWHEEL DR
ROCKLEDGE FL
32955-6026
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-0028
  • Fax: 321-636-0028
Mailing address:
  • Phone: 321-636-0028
  • Fax: 321-636-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number01029193A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: