MEDICARE: REMO RAINA

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	261QP2300X	Primary Care Clinic/Center	ME101124	FL

General Provider Information

NPI Number	:	1558510347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REMO RAINA

Provider Business Mailing Address
First Line	:	12439 SW KEATING DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34987-1920
Country	:	US
Telephone Number	:	772-240-9485
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 SE HILLMOOR DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7552
Country	:	US
Telephone Number	:	772-240-9485
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BINNO DHAR
Credential	:	M.D.
Telephone Number	:	772-240-9485

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	12/17/2008

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