Healthcare Provider Details

I. General information

NPI: 1184708935
Provider Name (Legal Business Name): SPECIALISTS IN PRIMARY HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 MASON CORBIN CT SUITE A
FORT MYERS FL
33907-4541
US

IV. Provider business mailing address

5030 MASON CORBIN CT SUITE B
FORT MYERS FL
33907-4548
US

V. Phone/Fax

Practice location:
  • Phone: 239-278-0330
  • Fax: 239-278-1348
Mailing address:
  • Phone: 239-278-0330
  • Fax: 239-278-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TEJVIR S CHADHA
Title or Position: PRESIDENT
Credential: MD
Phone: 239-278-0330