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General NPI Number Information
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NPI Number | 1952011363
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Entity Type | Organization
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Legal Business Name | CONCIERGE MEDICINE OF SWF, INC
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 2567 N TOLEDO BLADE BLVD
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City | NORTH PORT
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State | FL
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Zip | 34289-9305
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Country | US
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Telephone | 941-202-9266
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Fax |
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Provider Business Mailing Address
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Address Line | 3759 RADCLIFF AVE
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City | NORTH PORT
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State | FL
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Zip | 34287-5129
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Country | US
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Telephone | 941-539-4308
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | IVAN M DANKANICH
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Credential | ARNP
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Telephone | 941-539-4308
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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 |
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License Number State |
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