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General NPI Number Information
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NPI Number | 1386664621
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Entity Type | Organization
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Legal Business Name | HARBORSIDE INTERNAL MEDICINE PA
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 522 E MARION AVE
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City | PUNTA GORDA
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State | FL
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Zip | 33950-3875
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Country | US
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Telephone | 941-637-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 522 E MARION AVE
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City | PUNTA GORDA
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State | FL
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Zip | 33950-3814
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Country | US
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Telephone | 941-637-1119
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Fax | 941-637-1739
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY A JANZ
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Credential |
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Telephone | 941-637-1119
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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 | ME48819
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME71373
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License Number State | FL
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