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General NPI Number Information
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NPI Number | 1407946387
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Entity Type | Organization
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Legal Business Name | PULMONARY & CRITICAL CARE CONSULTANTS OF JACKSONVILLE PL
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 09/02/2008
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Provider Practice Location Address
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Address Line | 8075 GATE PKWY W SUITE 304
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City | JACKSONVILLE
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State | FL
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Zip | 32216-3684
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Country | US
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Telephone | 904-739-6666
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Fax | 904-739-1009
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Provider Business Mailing Address
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Address Line | PO BOX 551537
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City | JACKSONVILLE
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State | FL
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Zip | 32255-1537
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Country | US
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Telephone | 904-739-6666
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Fax | 904-739-1009
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMIT K CHAKRAVARTY
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Credential | M.D.
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Telephone | 904-739-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME53176
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License Number State | FL
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