MEDICARE: MINIMALLY INVASIVE SURGICAL PLLC

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	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1497300081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINIMALLY INVASIVE SURGICAL PLLC

Provider Business Mailing Address
First Line	:	6112 N MESA ST # 6027
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4516
Country	:	US
Telephone Number	:	575-288-5122
Fax Number	:

Provider Business Practice Location Address
First Line	:	4532 N MESA ST STE B2
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6286
Country	:	US
Telephone Number	:	575-288-5122
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. JOSEPH UNGAR
Credential	:	MD
Telephone Number	:	575-288-5122

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	08/09/2019

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