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General NPI Number Information
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NPI Number | 1972745883
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Entity Type | Organization
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Legal Business Name | KOSTIYA PEKI MD PA
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 9000 SW 152ND ST SUITE 105
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City | PALMETTO BAY
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State | FL
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Zip | 33157-1981
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Country | US
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Telephone | 786-445-0810
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 SW 152ND ST SUITE 105
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City | PALMETTO BAY
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State | FL
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Zip | 33157-1981
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Country | US
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Telephone | 786-445-0810
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | STACEY PEKI
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Credential | R.N.
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Telephone | 786-445-0810
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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 | ME95910
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License Number State | FL
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