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General NPI Number Information
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NPI Number | 1356580518
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Entity Type | Organization
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Legal Business Name | MIDWAY IMMUNOLOGY AND RESEARCH CENTER
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 356 E MIDWAY RD
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City | FORT PIERCE
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State | FL
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Zip | 34982-7148
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Country | US
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Telephone | 772-464-9746
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Fax |
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Provider Business Mailing Address
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Address Line | 356 E MIDWAY RD
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City | FORT PIERCE
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State | FL
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Zip | 34982-7148
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Country | US
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Telephone | 772-464-9746
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MOTI N RAMGOPAL
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Credential | MD
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Telephone | 772-464-9746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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