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General NPI Number Information
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NPI Number | 1417157173
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC CENTER FOR DISEASE OF
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 1250 S TAMIAMI TRAIL SUITE 101N
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City | SARASOTA
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State | FL
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Zip | 34239
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Country | US
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Telephone | 941-957-0007
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Fax | 941-957-1033
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Provider Business Mailing Address
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Address Line | 1250 S TAMIAMI TRAIL SUITE 101N
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City | SARASOTA
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State | FL
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Zip | 34239
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Country | US
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Telephone | 941-957-0007
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Fax | 941-957-1033
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD E WHEELER
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Credential | M.D.
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Telephone | 941-957-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 46625
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License Number State | FL
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