MEDICARE: PVD DIAGNOSTICS INC

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
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1366469272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PVD DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	6447 MIAMI LAKES DR E
Second Line	:	SUITE 225C
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2741
Country	:	US
Telephone Number	:	305-820-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	6447 MIAMI LAKES DR E
Second Line	:	SUITE 225C
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2741
Country	:	US
Telephone Number	:	305-820-7003
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LISA SMITH
Credential	:
Telephone Number	:	305-820-7003

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	08/22/2007

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