=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407740855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADISE IR LOCUMS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 07/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4205 W ATLANTIC AVE STE 102
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-3901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-894-1370
-----------------------------------------------------
Fax | 561-894-1372
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6574 N STATE ROAD 7 # 207
-----------------------------------------------------
City | COCONUT CREEK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33073-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-495-4834
-----------------------------------------------------
Fax | 561-894-1372
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | MIKHAIL HIGGINS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-894-1370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------