Healthcare Provider Details

I. General information

NPI: 1386234268
Provider Name (Legal Business Name): MEDEC MEDICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 N WICKHAM RD STE 9
MELBOURNE FL
32935-8300
US

IV. Provider business mailing address

1270 N WICKHAM RD STE 9
MELBOURNE FL
32935-8300
US

V. Phone/Fax

Practice location:
  • Phone: 321-567-2211
  • Fax: 321-286-0496
Mailing address:
  • Phone: 321-567-2211
  • Fax: 321-286-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: QAZIM SALIA
Title or Position: OWNER
Credential: PA
Phone: 312-719-2211