Provider Demographics
NPI:1558529842
Name:MIHAI S RADU M D P A
Entity Type:Organization
Organization Name:MIHAI S RADU M D P A
Other - Org Name:ATLANTIC COAST MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIHAI
Authorized Official - Middle Name:S
Authorized Official - Last Name:RADU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-783-6115
Mailing Address - Street 1:1980 N ATLANTIC AVE
Mailing Address - Street 2:STE 718
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-5213
Mailing Address - Country:US
Mailing Address - Phone:321-783-6115
Mailing Address - Fax:321-783-5524
Practice Address - Street 1:1980 N ATLANTIC AVE
Practice Address - Street 2:STE 718
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5213
Practice Address - Country:US
Practice Address - Phone:321-783-6115
Practice Address - Fax:321-783-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care