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General NPI Number Information
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NPI Number | 1841432325
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Entity Type | Organization
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Legal Business Name | INTERCOASTAL NEUROLOGY AND SLEEP CARE CENTER PLLC
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 381 PALM COAST PKWY SW SUITE 1804
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City | PALM COAST
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State | FL
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Zip | 32137-4781
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Country | US
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Telephone | 386-445-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 3868 VISTA LN
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City | ORCHARD LAKE
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State | MI
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Zip | 48323-1678
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Country | US
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Telephone | 386-445-2300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BHARAT TOLIA
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Credential | MD
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Telephone | 386-445-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301041039
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License Number State | MI
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