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General NPI Number Information
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NPI Number | 1538584990
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE CLINIC
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Dates
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Enumeration Date | 02/21/2014
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 14153 YOSEMITE DR
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City | HUDSON
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State | FL
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Zip | 34667-8060
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Country | US
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Telephone | 727-861-3232
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Fax | 352-684-2646
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Provider Business Mailing Address
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Address Line | 14153 YOSEMITE DR
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City | HUDSON
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State | FL
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Zip | 34667-8060
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Country | US
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Telephone | 727-861-3232
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Fax | 352-684-2646
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Authorized Official
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Title or Position | PRESIDENT
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Name | AYMAN OSMAN
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Credential | MD
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Telephone | 352-684-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | ME0069703
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License Number State | FL
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