Healthcare Provider Details

I. General information

NPI: 1407218043
Provider Name (Legal Business Name): CHEN NEIGHBORHOOD MEDICAL OF NORTH LAKELAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N FLORIDA AVE
LAKELAND FL
33801-4902
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5742
US

V. Phone/Fax

Practice location:
  • Phone: 305-628-6117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER CHEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 305-831-4760