=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427727619
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITEVEINSBOCA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2021
-----------------------------------------------------
Last Update Date | 11/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 S OCEAN BLVD APT 204
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-6242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-693-2063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 S OCEAN BLVD APT 204
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-6242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-693-2063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRADLEY ARDEN RADWANER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 917-693-2063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------