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General NPI Number Information
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NPI Number | 1376958462
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Entity Type | Organization
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Legal Business Name | BREVARD PRIMARY CARE LLC
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 2328 CITADEL WAY STE 103-319
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City | MELBOURNE
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State | FL
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Zip | 32940-6459
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Country | US
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Telephone | 321-757-1900
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Fax | 866-376-2481
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Provider Business Mailing Address
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Address Line | 2328 CITADEL WAY STE 103-319
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City | MELBOURNE
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State | FL
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Zip | 32940-6459
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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 | PRACTICE OWNER
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Name | DR. BHAVANI M PUSKUR
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Credential | M.D.
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Telephone | 321-948-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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