| Organization Name: | NORTHERN MEDICAL CENTER INC |
| NPI Number: | 1134567613 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIIL SUPISHCHEV (OWNER) |
| Mailing Address: | 12450 Tamiami Trl S Suite E North Port |
| State: | FL US |
| Postal Code: | 342871473 |
| Phone Number: | 9412574763 |
| Fax Number: | 9412574766 |
| NPI Enumeration Date: | 06/06/2013 |
| NPI Last Update Date: | 10/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |