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General NPI Number Information
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NPI Number | 1013157163
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF COLORECTAL HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 218 SW ATLANTA AVE SUITE D
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City | STUART
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State | FL
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Zip | 34994-2034
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Country | US
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Telephone | 772-539-9556
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Fax |
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Provider Business Mailing Address
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Address Line | 218 SW ATLANTA AVE
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City | STUART
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State | FL
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Zip | 34994-2034
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Country | US
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Telephone | 772-539-9556
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DEBORAH ANN DEMARTA
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Credential | M.D.
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Telephone | 772-539-9556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 69555
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License Number State | FL
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