Healthcare Provider Details

I. General information

NPI: 1881690931
Provider Name (Legal Business Name): SEIICHI NODA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 KENNERLY RD SUITE 403
SAINT LOUIS MO
63128-2197
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 314-880-6676
  • Fax: 314-842-4372
Mailing address:
  • Phone: 321-434-3455
  • Fax: 321-434-3456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME150578
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number200146129
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: