Organization
EKG PANEL OF BLAKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARINA COSTOPOULOS (ADMINISTRATOR)
(941) 365-8532
Entity
Organization
Contact information
Practice address
2020 59TH ST W, BLAKE MEDICAL CENTER, BRADENTON, FL 34209-4604
(941) 321-2830
(504) 588-2165
Mailing address
PO BOX 25548, EKG PANEL OF BLAKE, SARASOTA, FL 34277-2548
(941) 321-2830
(504) 588-2165
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
FL
Other
Enumeration date
02/24/2015
Last updated
03/19/2024
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