Healthcare Provider Details

I. General information

NPI: 1437437480
Provider Name (Legal Business Name): I CARE HEALING AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 E IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34744-5600
US

IV. Provider business mailing address

2901 E IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34744-5600
US

V. Phone/Fax

Practice location:
  • Phone: 407-268-6004
  • Fax: 407-809-5251
Mailing address:
  • Phone: 407-268-6004
  • Fax: 407-809-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4868
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME95960
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMA53070
License Number StateFL

VIII. Authorized Official

Name: JUNAID SYED
Title or Position: OWNER
Credential: MD
Phone: 407-268-6004