Doctor Name: | JUAN PREMOLI |
NPI Number: | 1053375584 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | ME87618 |
Business Practice Address: | 21150 Biscayne Blvd 404 Aventura, FL - 331801226 |
Business Phone Number: | 3054669111 |
Business Fax Number: | 3054669127 |
Mailing Address: | 2234 Colonial Blvd, Managed Care Dept FORT MYERS |
State: | FL |
Postal Code: | 339071412 |
Phone Number: | 2399317342 |
Fax Number: | 2399317385 |
NPI Enumeration Date: | 04/13/2006 |
NPI Last Update Date: | 09/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | ME87618 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
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. |