Organization Name: | PRIMARY CARE OF DUNDEE |
NPI Number: | 1548523467 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MOSTAFA MACIDA (OWNER) |
Mailing Address: | 28279 Hwy 27 Dundee |
State: | FL US |
Postal Code: | 338384270 |
Phone Number: | 8634387920 |
Fax Number: | 8634387919 |
NPI Enumeration Date: | 06/18/2012 |
NPI Last Update Date: | 06/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |