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General NPI Number Information
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NPI Number | 1366970162
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Entity Type | Organization
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Legal Business Name | MIDWEST VASCULAR INSTITUTE INC
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3405 6TH ST
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City | BROOKINGS
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State | SD
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Zip | 57006-4417
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Country | US
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Telephone | 866-512-6992
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Fax | 760-300-3576
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Provider Business Mailing Address
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Address Line | 3405 6TH ST
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City | BROOKINGS
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State | SD
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Zip | 57006-4417
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Country | US
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Telephone | 866-512-6992
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Fax | 760-300-3576
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMIEL MOSHFEGH
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Credential | MD
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Telephone | 866-512-6992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 10372
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License Number State | SD
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