Healthcare Provider Details

I. General information

NPI: 1750718896
Provider Name (Legal Business Name): MRDICAL CLINICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SE JENNINGS RD APT. 125
PORT ST LUCIE FL
34952-7701
US

IV. Provider business mailing address

1111 HYPOLUXO RD SUITE 107
LANTANA FL
33462-4271
US

V. Phone/Fax

Practice location:
  • Phone: 772-337-5222
  • Fax: 772-337-5333
Mailing address:
  • Phone: 561-586-3400
  • Fax: 561-585-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number19488
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN LOUIS NEMEROFSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-586-3400