MEDICARE: INTERNAL MEDICINE CONSULTANTS OF SAINT LUCIE COUNTY 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		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538150826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE CONSULTANTS OF SAINT LUCIE COUNTY LLC

Provider Business Mailing Address
First Line	:	2401 FRIST BLVD
Second Line	:	SUITE 1
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4839
Country	:	US
Telephone Number	:	772-464-0033
Fax Number	:	772-467-1150

Provider Business Practice Location Address
First Line	:	2401 FRIST BLVD
Second Line	:	SUITE 1
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4839
Country	:	US
Telephone Number	:	772-464-0033
Fax Number	:	772-467-1150

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NAHEED SHAREEF
Credential	:
Telephone Number	:	772-464-0033

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	09/05/2012

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