Healthcare Provider Details

I. General information

NPI: 1437355666
Provider Name (Legal Business Name): INSTITUTE OF ELECTROPHYSIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 OLEANDER DR SUITE 102
MYRTLE BEACH SC
29577-5720
US

IV. Provider business mailing address

PO BOX 810
NORTH MYRTLE BEACH SC
29597-0810
US

V. Phone/Fax

Practice location:
  • Phone: 843-602-2882
  • Fax: 843-946-0022
Mailing address:
  • Phone: 843-602-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number22341
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: OMAR JARAKI
Title or Position: DIRECTOR
Credential: MD
Phone: 843-602-6262