Kochicheril N Moni, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

0101031293 Issued in VA

Practice address

1116 SW 11TH Street
Live Oak, FL 32064

Phone

(386) 362-0820

Fax

(386) 362-0821

NPI assigned

Jun 30, 2005

Reactivated

Mar 30, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315440000000",
    "number": "1942207485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 SW 11TH STREET",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "32064",
            "telephone_number": "386-362-0820",
            "fax_number": "386-362-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 SW 11TH STREET",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "32064",
            "telephone_number": "386-362-0820",
            "fax_number": "386-362-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONI",
        "first_name": "KOCHICHERIL",
        "middle_name": "N",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2011-09-08",
        "deactivation_date": "2006-03-17",
        "reactivation_date": "2006-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101031293",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0101031293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6085164",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meridian Behavioral Healthcare, Inc.
• Jennifer Sullivan Merola, APRN
• Lindsey Allen Minshew, APRN
• Rosalie Delaney Mitchell, LM, CPM
• Leslie Mobley, PTA
• Patricia Ann Morgan, RN
• Melanie Alyse Morris, B.S.ED
• Michelle Denise Morris, ARNP
• Julie Mossburg, LMT
• Gabriel Bezel Mufuka, M.D

• Cardiovascular Disease Physician in Live Oak, FL
• Providers in Live Oak, FL by specialty
• Cardiovascular Disease Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.