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General NPI Number Information
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NPI Number | 1366875387
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Entity Type | Organization
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Legal Business Name | CANCER CENTER OF MELBOURNE LLC
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 415 S. WICKHAM RD.
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City | MELBOURNE
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State | FL
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Zip | 32904
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Country | US
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Telephone | 321-821-2282
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Fax | 321-821-0666
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Provider Business Mailing Address
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Address Line | 415 S. WICKHAM RD.
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City | MELBOURNE
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State | FL
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Zip | 32904
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Country | US
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Telephone | 321-821-2282
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Fax | 321-821-0666
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WASFI A MAKAR
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Credential | M.D.
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Telephone | 321-960-1587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number | ME56764
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License Number State | FL
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