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General NPI Number Information
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NPI Number | 1770766289
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Entity Type | Organization
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Legal Business Name | RED STAR HOLDINGS INC.
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 13733 OFFICE PARK COURT
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City | HUDSON
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State | FL
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Zip | 34667
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Country | US
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Telephone | 727-862-2580
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Fax | 727-862-9458
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Provider Business Mailing Address
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Address Line | 13733 OFFICE PARK COURT
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City | HUDSON
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State | FL
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Zip | 34667
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Country | US
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Telephone | 727-862-2580
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Fax | 727-862-9458
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PRESIDENT
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Name | RADHIKA MENON
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Credential | M.D.
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Telephone | 727-862-2580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME78480
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License Number State | FL
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