Healthcare Provider Details

I. General information

NPI: 1316785017
Provider Name (Legal Business Name): DIABETES THYROID & HORMONE CENTER OF THE TREASURE COAST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SE GOLDTREE DR STE 103
PORT ST LUCIE FL
34952-7582
US

IV. Provider business mailing address

1400 SE GOLDTREE DR STE 103
PORT ST LUCIE FL
34952-7582
US

V. Phone/Fax

Practice location:
  • Phone: 772-398-7814
  • Fax: 772-398-7812
Mailing address:
  • Phone: 772-398-7814
  • Fax: 772-398-7812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AHMET BAHADIR ERGIN
Title or Position: OWNER
Credential: MD
Phone: 216-394-6700