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NPI Profile for MODERN VASCULAR OF SOUTHAVEN LLC in SOUTHAVEN, MS.
A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Vascular & Interventional Radiology |
2085R0204X | 94 | Physician/Interventional Radiology | |
Vascular-Interventional Technology Radiologic Technologist |
2471V0106X |
| NPI Number | 1174171441 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 08/29/2019 | |
| Last updated | 08/29/2019 - About 7 years ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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MODERN VASCULAR OF SOUTHAVEN, LLC