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General NPI Number Information
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NPI Number | 1659517076
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Entity Type | Organization
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Legal Business Name | ARELIS M. MADERA, MD, PA
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 3611 TAMIAMI TRL SUITE B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5528
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Country | US
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Telephone | 941-235-0542
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Fax | 941-235-0545
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Provider Business Mailing Address
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Address Line | 3611 TAMIAMI TRL SUITE B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5528
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Country | US
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Telephone | 941-235-0542
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Fax | 941-235-0545
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARELIS M MADERA
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Credential | MD
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Telephone | 941-235-0542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME74893
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License Number State | FL
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