MEDICARE: FSCZ LLC

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	207R00000X	Internal Medicine Physician	ME82883	FL

General Provider Information

NPI Number	:	1255675831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FSCZ LLC

Provider Business Mailing Address
First Line	:	2436 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2436 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2002
Country	:	US
Telephone Number	:	904-388-3351
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DR. FADI R CHALHOUB
Credential	:	M.D.
Telephone Number	:	904-388-3351

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	11/20/2012

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Directions to “FSCZ LLC ” Practice Location

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