Healthcare Provider Details

I. General information

NPI: 1780509018
Provider Name (Legal Business Name): MED FAST USA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13468 PALM BEACH BLVD
FORT MYERS FL
33905-2168
US

IV. Provider business mailing address

13468 PALM BEACH BLVD
FORT MYERS FL
33905-2168
US

V. Phone/Fax

Practice location:
  • Phone: 239-270-3973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEKAA'EL MAHMOUD
Title or Position: MBR
Credential:
Phone: 239-270-3973