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General NPI Number Information
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NPI Number | 1114701497
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Entity Type | Organization
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Legal Business Name | PREMIER CARDIOLOGY OF VERO BEACH
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 787 37TH ST STE 250
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City | VERO BEACH
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State | FL
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Zip | 32960-7305
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Country | US
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Telephone | 772-494-0794
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Fax | 772-494-0745
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Provider Business Mailing Address
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Address Line | 787 37TH ST STE 250
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City | VERO BEACH
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State | FL
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Zip | 32960-7305
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Country | US
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Telephone | 772-494-0794
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Fax | 772-494-0745
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Authorized Official
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Title or Position | CEO
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Name | VIKRANTH GONGIDI
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Credential | DO
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Telephone | 772-494-0794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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