Provider Demographics
NPI:1437478260
Name:ENLIGHTEN RADIOLOGY OF FLORIDA PLLC
Entity type:Organization
Organization Name:ENLIGHTEN RADIOLOGY OF FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-750-4916
Mailing Address - Street 1:1751 3RD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2670
Mailing Address - Country:US
Mailing Address - Phone:415-750-4916
Mailing Address - Fax:415-459-4916
Practice Address - Street 1:7400 SW 87TH AVE
Practice Address - Street 2:SUITE 120A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5458
Practice Address - Country:US
Practice Address - Phone:305-595-4425
Practice Address - Fax:305-595-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME721002085R0204X, 2085R0202X
FLME842802085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty