Healthcare Provider Details

I. General information

NPI: 1053681924
Provider Name (Legal Business Name): INSTITUTE FOR HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S HARBOR CITY BLVD 100
MELBOURNE FL
32901-1963
US

IV. Provider business mailing address

20 E MELBOURNE AVE 104
MELBOURNE FL
32901-5970
US

V. Phone/Fax

Practice location:
  • Phone: 321-951-7404
  • Fax: 321-723-8527
Mailing address:
  • Phone: 321-951-7404
  • Fax: 321-723-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number604211
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number604211
License Number StateFL

VIII. Authorized Official

Name: RAJIV CHANDRA
Title or Position: OFFICER FOR MDMR-TRUMED ED, INC
Credential: M.D.
Phone: 321-951-7404