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NPI Code Detail

MEDICARE: COASTAL PULMONARY AND SLEEP CENTER LLC

MEDICARE: COASTAL PULMONARY AND SLEEP CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RS0012XSleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number : 1013664390
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL PULMONARY AND SLEEP CENTER LLC
Provider Business Mailing Address
First Line : 140 6TH AVE
Second Line :
City : INDIALANTIC
State : FL
Zip : 32903-3204
Country : US
Telephone Number : 321-312-3501
Fax Number :
Provider Business Practice Location Address
First Line : 140 6TH AVE
Second Line :
City : INDIALANTIC
State : FL
Zip : 32903-3204
Country : US
Telephone Number : 321-312-3501
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : PRAKASH V REDDY
Credential : MD
Telephone Number : 321-312-3501
Provider Enumeration Date : 03/07/2022
Last Update Date : 03/07/2022

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Directions to “COASTAL PULMONARY AND SLEEP CENTER LLC ” Practice Location

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