| Boutiq Medical Clinic Llc | |
|
1430 N Mills Ave Ste 120 Orlando FL 32803-1877 | |
| (407) 777-2449 | |
| Not Available |
| Full Name | Boutiq Medical Clinic Llc |
|---|---|
| Speciality | Nurse Practitioner - Family |
| Location | 1430 N Mills Ave Ste 120, Orlando, Florida |
| Authorized Official Name and Position | Karen L Buckalew (PRESIDENT/OWNER) |
| Authorized Official Contact | 4077772449 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boutiq Medical Clinic Llc 1815 Gerda Ter Orlando FL 32804-5934 Ph: (407) 446-5425 | Boutiq Medical Clinic Llc 1430 N Mills Ave Ste 120 Orlando FL 32803-1877 Ph: (407) 777-2449 |
| NPI Number | 1558947499 |
|---|---|
| Provider Enumeration Date | 03/22/2021 |
| Last Update Date | 04/07/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558947499 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
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