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General NPI Number Information
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NPI Number | 1194873018
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Entity Type | Organization
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Legal Business Name | COASTAL CARE CORPORATION
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 11600 SE FEDERAL HWY
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City | HOBE SOUND
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State | FL
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Zip | 33455-5213
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Country | US
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Telephone | 772-223-4940
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Fax | 772-223-4944
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Provider Business Mailing Address
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Address Line | PO BOX 417
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City | STUART
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State | FL
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Zip | 34995-0417
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Country | US
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Telephone | 772-223-5665
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Fax | 772-223-5646
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Authorized Official
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Title or Position | MANAGER
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Name | KEVIN LITKE
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Credential |
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Telephone | 772-223-4940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1996125033
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License Number State | FL
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