Organization Name: | GOODWILLUS MEDICAL CLINIC, LLC |
NPI Number: | 1922318948 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ADETOLA ADEYANJU-ISHOLA (PRESIDENT/CEO) |
Mailing Address: | 7037 State Road 52 Hudson |
State: | FL US |
Postal Code: | 346676706 |
Phone Number: | 7278623600 |
Fax Number: | 7278628899 |
NPI Enumeration Date: | 10/08/2010 |
NPI Last Update Date: | 10/28/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME56548 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |