Healthcare Provider Details

I. General information

NPI: 1588870687
Provider Name (Legal Business Name): WILCHEL POLYNICE RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15913 SW 63RD TER
MIAMI FL
33193-5562
US

IV. Provider business mailing address

15913 SW 63RD TER
MIAMI FL
33193-5562
US

V. Phone/Fax

Practice location:
  • Phone: 786-499-8645
  • Fax: 305-752-3260
Mailing address:
  • Phone: 786-499-8645
  • Fax: 305-752-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT 8744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: