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General NPI Number Information
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NPI Number | 1467628156
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Entity Type | Organization
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Legal Business Name | THORACIC SURGERY OF INDIAN RIVER LLC
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 14430 US HIGHWAY 1 SUITE 102
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City | SEBASTIAN
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State | FL
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Zip | 32958-3289
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Country | US
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Telephone | 772-589-2009
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Fax | 772-589-2299
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Provider Business Mailing Address
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Address Line | 14430 US HIGHWAY 1 SUITE 102
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City | SEBASTIAN
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State | FL
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Zip | 32958-3289
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Country | US
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Telephone | 772-589-2009
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Fax | 772-589-2299
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. PETER A SEIRAFI
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Credential | M.D.
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Telephone | 772-589-2009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | ME80733
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License Number State | FL
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