Individual
MR. KOCHICHERIL N MONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1116 SW 11TH STREET, LIVE OAK, FL 32064
(386) 362-0820
(386) 362-0821
Mailing address
1116 SW 11TH STREET, LIVE OAK, FL 32064
(386) 362-0820
(386) 362-0821
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101031293
VA
207RC0000X
Cardiovascular Disease Physician
Primary
0101031293
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6085164
—
VA
Enumeration date
06/30/2005
Last updated
09/08/2011
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