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General NPI Number Information
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NPI Number | 1063667996
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY AND DIABETES CONSULTANTS
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 4915 S CONGRESS AVE SUITE D
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City | LAKE WORTH
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State | FL
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Zip | 33461-4734
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Country | US
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Telephone | 561-964-1411
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Fax | 561-964-3039
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Provider Business Mailing Address
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Address Line | 4915 S CONGRESS AVE SUITE D
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City | LAKE WORTH
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State | FL
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Zip | 33461-4734
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Country | US
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Telephone | 561-964-1411
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Fax | 561-964-3039
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Authorized Official
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Title or Position | OWNER
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Name | GULNAZ MIRZA
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Credential | M.D. P.A.
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Telephone | 561-964-1411
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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 | 07717
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License Number State | FL
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