Provider Demographics
NPI:1326364076
Name:SOUTH FLORIDA INTERVENTIONAL RADIOLOGY, PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA INTERVENTIONAL RADIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-855-0306
Mailing Address - Street 1:PO BOX 63225
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3225
Mailing Address - Country:US
Mailing Address - Phone:305-855-0306
Mailing Address - Fax:
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE 740
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4556
Practice Address - Country:US
Practice Address - Phone:305-855-0306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME761542085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME76154OtherMEDICAL LICENSE