Healthcare Provider Details

I. General information

NPI: 1669798567
Provider Name (Legal Business Name): MCM PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 UNIVERSITY BLVD SUITE 206
JUPITER FL
33458-2788
US

IV. Provider business mailing address

PO BOX 69
JUPITER FL
33468-0069
US

V. Phone/Fax

Practice location:
  • Phone: 561-932-0995
  • Fax:
Mailing address:
  • Phone: 561-932-0995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAZIN SHIKARA
Title or Position: PRESIDENT
Credential:
Phone: 561-932-0995