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General NPI Number Information
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NPI Number | 1093439820
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Entity Type | Organization
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Legal Business Name | CULINARY MD INC
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 10175 FORTUNE PKWY UNIT 402
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6750
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Country | US
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Telephone | 904-463-2548
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Fax |
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Provider Business Mailing Address
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Address Line | 2939 FRONT RD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5624
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SUWARNA M TILAK
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Credential | MD
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Telephone | 904-463-2548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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