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General NPI Number Information
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NPI Number | 1437478260
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Entity Type | Organization
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Legal Business Name | ENLIGHTEN RADIOLOGY OF FLORIDA PLLC
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 7400 SW 87TH AVE SUITE 120A
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City | MIAMI
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State | FL
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Zip | 33173-5458
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Country | US
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Telephone | 305-595-4425
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Fax | 305-595-1355
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Provider Business Mailing Address
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Address Line | 1751 3RD ST SUITE 102
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City | NORCO
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State | CA
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Zip | 92860-2670
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Country | US
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Telephone | 415-750-4916
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Fax | 415-459-4916
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MICHAEL A TAYLOR
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Credential | M.D.
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Telephone | 415-750-4916
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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 | ME72100
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | ME84280
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME72100
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License Number State | FL
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