Healthcare Provider Details

I. General information

NPI: 1801312525
Provider Name (Legal Business Name): MODERN MEDICAL CARE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 UNIVERSITY PKWY STE 216
SARASOTA FL
34243-2809
US

IV. Provider business mailing address

3401 BAYOU SOUND
LONGBOAT KEY FL
34228-3011
US

V. Phone/Fax

Practice location:
  • Phone: 941-359-8420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER FINE
Title or Position: PRESIDENT
Credential: MD
Phone: 267-312-6283