Healthcare Provider Details

I. General information

NPI: 1043551468
Provider Name (Legal Business Name): ID CONSULTS AND SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 NORTHSIDE DR SUITE 101
KEY WEST FL
33040-8012
US

IV. Provider business mailing address

3142 NORTHSIDE DR STE 101
KEY WEST FL
33040-8012
US

V. Phone/Fax

Practice location:
  • Phone: 305-615-3300
  • Fax:
Mailing address:
  • Phone: 305-615-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRYL WALLACE
Title or Position: MANAGER
Credential:
Phone: 305-615-3300