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General NPI Number Information
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NPI Number | 1275904823
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Entity Type | Organization
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Legal Business Name | MIDWEST CONCIERGE OF NAPLES, LLC
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 501 GOODLETTE RD N STE A103
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City | NAPLES
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State | FL
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Zip | 34102-5663
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Country | US
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Telephone | 239-529-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 13386 KENT ST
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City | NAPLES
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State | FL
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Zip | 34109-3929
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Country | US
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Telephone | 239-529-4100
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Fax | 954-510-2086
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Authorized Official
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Title or Position | MANAGER
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Name | LAURIE A TROUP
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Credential | DO
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Telephone | 239-529-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OS11799
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License Number State | FL
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