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1731 Banaghen Dr Melbourne FL 32940-6012 | |
(614) 404-0972 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 1731 Banaghen Dr, Melbourne, Florida |
Authorized Official Name and Position | Chaithanya Deepthi Buddha (PRESIDENT) |
Authorized Official Contact | 6144040972 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1731 Banaghen Dr Melbourne FL 32940-6012 Ph: (614) 404-0972 | 1731 Banaghen Dr Melbourne FL 32940-6012 Ph: (614) 404-0972 |
NPI Number | 1144842246 |
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Provider Enumeration Date | 05/12/2020 |
Last Update Date | 07/09/2020 |
Identifier | Type | State | Issuer |
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1144842246 | NPI | - | NPPES |
14Y3K | Other | FL | FLORIDA BLUE CROSS BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Donald H. Dehaven Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8057 Spyglass Hill Rd, Unit 104, Melbourne, FL 32940 Phone: 321-622-8943 Fax: 321-622-8945 | |
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