Healthcare Provider Details

I. General information

NPI: 1851676472
Provider Name (Legal Business Name): MEDI-FAST URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 SW PRIMA VISTA BLVD SUITE 102
PORT ST LUCIE FL
34983-1835
US

IV. Provider business mailing address

PO BOX 69
JUPITER FL
33468-0069
US

V. Phone/Fax

Practice location:
  • Phone: 561-932-0995
  • Fax: 561-932-0997
Mailing address:
  • Phone: 561-932-0995
  • Fax: 561-932-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAZIN M SHIKARA
Title or Position: PRESIDENT
Credential:
Phone: 561-779-1652