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General NPI Number Information
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NPI Number | 1184107070
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Entity Type | Organization
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Legal Business Name | PULSE, PA
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 3420 TAMIAMI TRL UNIT 2
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8126
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Country | US
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Telephone | 941-629-2111
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Fax | 941-627-5377
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Provider Business Mailing Address
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Address Line | 3420 TAMIAMI TRL UNIT 2
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8126
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Country | US
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Telephone | 941-629-2111
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Fax | 941-627-5377
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MICHELLE BACKUS-WADE
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Credential |
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Telephone | 941-629-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME107666
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License Number State | FL
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