Healthcare Provider Details

I. General information

NPI: 1982346326
Provider Name (Legal Business Name): CAREMED WEIGHT LOSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4719 HIGHWAY 90
MARIANNA FL
32446-7839
US

IV. Provider business mailing address

4719 HIGHWAY 90
MARIANNA FL
32446-7839
US

V. Phone/Fax

Practice location:
  • Phone: 850-526-3314
  • Fax: 850-526-5022
Mailing address:
  • Phone: 850-526-3314
  • Fax: 850-526-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MURALI MADDIPATI
Title or Position: OWNER
Credential: MD
Phone: 850-526-3314