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General NPI Number Information
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NPI Number | 1659762235
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Entity Type | Organization
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Legal Business Name | BICOL MD PA
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 951 NW 13TH ST STE 3E
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City | BOCA RATON
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State | FL
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Zip | 33486-2337
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Country | US
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Telephone | 561-368-5558
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Fax | 561-368-7907
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Provider Business Mailing Address
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Address Line | 951 NW 13TH ST STE 3E
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City | BOCA RATON
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State | FL
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Zip | 33486-2337
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | MITCHELL SCHUSTER
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Credential | M.D.
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Telephone | 561-368-5558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | ME79854
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License Number State | FL
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