| Organization Name: | COVENANT MEDICAL CLINIC |
| NPI Number: | 1528380748 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MOBOLANLE FADARE (OWNER) |
| Mailing Address: | 2812 W Dr Martin Luther King Jr Blvd Suite 2 Tampa |
| State: | FL US |
| Postal Code: | 336076306 |
| Phone Number: | 8138740850 |
| Fax Number: | 8138740590 |
| NPI Enumeration Date: | 02/16/2010 |
| NPI Last Update Date: | 02/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 126336 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |