MEDICARE: ENDOCRINE CRE CENTER, PLLC

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1174466064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDOCRINE CRE CENTER, PLLC

Provider Business Mailing Address
First Line	:	8048 GREEN GLADE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7302
Country	:	US
Telephone Number	:	313-450-5274
Fax Number	:

Provider Business Practice Location Address
First Line	:	8048 GREEN GLADE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7302
Country	:	US
Telephone Number	:	313-450-5274
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SALMA MAKHOUL AHWACH
Credential	:
Telephone Number	:	313-450-5274

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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