Provider Demographics
NPI:1366970162
Name:MIDWEST VASCULAR INSTITUTE INC
Entity type:Organization
Organization Name:MIDWEST VASCULAR INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHFEGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-512-6992
Mailing Address - Street 1:3405 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-4417
Mailing Address - Country:US
Mailing Address - Phone:866-512-6992
Mailing Address - Fax:760-300-3576
Practice Address - Street 1:3405 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-4417
Practice Address - Country:US
Practice Address - Phone:866-512-6992
Practice Address - Fax:760-300-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD103722085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty