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General NPI Number Information
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NPI Number | 1750589487
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Entity Type | Organization
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Legal Business Name | MC MEDICAL ASSOCIATES PA
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 08/15/2007
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Provider Practice Location Address
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Address Line | 1519 SE 47TH ST
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City | CAPE CORAL
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State | FL
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Zip | 33904-9637
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Country | US
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Telephone | 239-823-7829
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Fax |
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Provider Business Mailing Address
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Address Line | 1519 SE 47TH ST
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City | CAPE CORAL
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State | FL
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Zip | 33904-9637
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Country | US
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Telephone | 239-823-7829
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELE ANTOINETTE CANDELORE
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Credential | DO
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Telephone | 239-823-7829
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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 | OS 8236
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License Number State | FL
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