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General NPI Number Information
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NPI Number | 1659046498
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Entity Type | Organization
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Legal Business Name | BLUE CONCIERGE MEDICINE LLC
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Dates
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Enumeration Date | 08/13/2021
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 700 2ND AVE N STE 305
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City | NAPLES
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State | FL
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Zip | 34102-5702
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Country | US
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Telephone | 239-610-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 700 2ND AVE N STE 305
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City | NAPLES
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State | FL
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Zip | 34102-5702
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Country | US
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Telephone | 239-610-1230
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Fax |
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Authorized Official
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Title or Position | DO
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Name | REBECCA MIKNAITIS
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Credential | DO
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Telephone | 239-610-1230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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