MEDICARE: ENDOCRINOLOGY AND DIABETES CONSULTANTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	07717	FL

General Provider Information

NPI Number	:	1063667996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDOCRINOLOGY AND DIABETES CONSULTANTS

Provider Business Mailing Address
First Line	:	4915 S CONGRESS AVE
Second Line	:	SUITE D
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4734
Country	:	US
Telephone Number	:	561-964-1411
Fax Number	:	561-964-3039

Provider Business Practice Location Address
First Line	:	4915 S CONGRESS AVE
Second Line	:	SUITE D
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4734
Country	:	US
Telephone Number	:	561-964-1411
Fax Number	:	561-964-3039

Authorized Official
Title or Position	:	OWNER
Name	:	GULNAZ MIRZA
Credential	:	M.D. P.A.
Telephone Number	:	561-964-1411

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	11/19/2008

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