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General NPI Number Information
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NPI Number | 1689184335
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Entity Type | Organization
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Legal Business Name | HARBOR MEDICAL GROUP LLC
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 21202 OLEAN BLVD STE C1
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6725
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Country | US
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Telephone | 941-889-7440
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Fax | 941-391-6089
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Provider Business Mailing Address
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Address Line | 21202 OLEAN BLVD STE C1
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6725
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Country | US
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Telephone | 941-889-7440
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Fax | 941-391-6089
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Authorized Official
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Title or Position | OWNER
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Name | AHSAN KAMAL
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Credential | MD
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Telephone | 941-889-7440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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