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General NPI Number Information
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NPI Number | 1710216262
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Entity Type | Organization
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Legal Business Name | BREVARD INTERNAL MEDICINE & WALK-IN CLINIC
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Dates
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Enumeration Date | 12/11/2009
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 2795 W NEW HAVEN AVE
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City | W MELBOURNE
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State | FL
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Zip | 32904-3705
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Country | US
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Telephone | 321-622-8626
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Fax | 321-622-8627
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Provider Business Mailing Address
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Address Line | PO BOX 411685
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City | MELBOURNE
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State | FL
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Zip | 32941-1685
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Country | US
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Telephone | 321-622-8626
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Fax | 321-622-8627
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. ARAVIND KUMAR
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Credential | MD
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Telephone | 321-622-8626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ARNP 2107012
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME97764
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License Number State | FL
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