VIVANT MEDICAL GROUP LLC NPI 1124652425

NPI Information

VIVANT MEDICAL GROUP LLC is a general practice in Tampa, FL. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee VIVANT MEDICAL GROUP LLC NPI is 1124652425. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6214 MEMORIAL HWY STE B
TAMPA, FL
ZIP 33615-507
Phone: (800) 574-9491
Fax: (800) 547-2802

The provider's authorized official is Daphnee Moise-johnson .
The authorized official title is President and has the following contact phone number (800) 574-9491.

The enumeration date for this NPI number is 2/25/2020 and was last updated on 7/6/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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