Provider Demographics
NPI:1801683727
Name:MS MEDICAL DIAGNOSTIC
Entity type:Organization
Organization Name:MS MEDICAL DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL MEDICINE & REHABILITATION
Authorized Official - Prefix:
Authorized Official - First Name:MAKSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHMARGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-728-4067
Mailing Address - Street 1:1420 LAKEFRONT DR UNIT 3315
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-1605
Mailing Address - Country:US
Mailing Address - Phone:347-728-4067
Mailing Address - Fax:
Practice Address - Street 1:5511 SWIFT RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6209
Practice Address - Country:US
Practice Address - Phone:941-921-7462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty