MEDICARE: DR. SEIICHI NODA MD

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME150578	FL
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	200146129	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV584	OTHER	FL	FL MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881690931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEIICHI NODA MD

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-434-3455
Fax Number	:	321-434-3456

Provider Business Practice Location Address
First Line	:	10012 KENNERLY RD
Second Line	:	SUITE 403
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2197
Country	:	US
Telephone Number	:	314-880-6676
Fax Number	:	314-842-4372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/21/2021

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Directions to “ DR. SEIICHI NODA MD” Practice Location

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