Healthcare Provider Details

I. General information

NPI: 1982781688
Provider Name (Legal Business Name): IDICULA MEDICAL ASSOCIATES MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 CORTEZ BLVD
BROOKSVILLE FL
34613
US

IV. Provider business mailing address

10065 CORTEZ BLVD
WEEKI WACHEE FL
34613-6389
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-4660
  • Fax: 352-596-4674
Mailing address:
  • Phone: 352-596-4660
  • Fax: 352-596-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH IDICULA
Title or Position: PRESIDENT
Credential:
Phone: 352-596-4660