Doctor Name: | MR. KOCHICHERIL N MONI |
NPI Number: | 1942207485 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 0101031293 |
Business Practice Address: | 1116 Sw 11th Street Live Oak, FL - 32064 |
Business Phone Number: | 3863620820 |
Business Fax Number: | 3863620821 |
Mailing Address: | 1116 Sw 11th Street, LIVE OAK |
State: | FL |
Postal Code: | 32064 |
Phone Number: | 3863620820 |
Fax Number: | 3863620821 |
NPI Enumeration Date: | 06/30/2005 |
NPI Last Update Date: | 09/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | 03/17/2006 |
NPI Reactivation Date: | 03/30/2006 |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 0101031293 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |