Healthcare Provider Details

I. General information

NPI: 1750787982
Provider Name (Legal Business Name): IAH OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 SOUTHPOINT BLVD STE. 100
JACKSONVILLE FL
32216-0986
US

IV. Provider business mailing address

PO BOX 639295 DEPT 40599
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-1915
  • Fax: 904-281-1119
Mailing address:
  • Phone: 248-824-6600
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY MULLIGAN
Title or Position: CFO
Credential:
Phone: 248-824-6600