MEDICARE: FLORIDA NEUROLOGY CLINICS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME83217	FL

General Provider Information

NPI Number	:	1194098616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA NEUROLOGY CLINICS PA

Provider Business Mailing Address
First Line	:	1258 WEST BAY DR.
Second Line	:	SUITE H
City	:	LARGO
State	:	FL
Zip	:	33770-2245
Country	:	US
Telephone Number	:	727-584-3313
Fax Number	:	727-584-3315

Provider Business Practice Location Address
First Line	:	1258 W BAY DR
Second Line	:	STE H
City	:	LARGO
State	:	FL
Zip	:	33770-2242
Country	:	US
Telephone Number	:	727-584-3313
Fax Number	:	727-584-3315

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OBI OKONKWO-ONUIGBO
Credential	:	M.D.
Telephone Number	:	727-584-3313

Provider Enumeration Date	:	02/14/2012
Last Update Date	:	02/14/2012

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