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17123 Commerce Centre Dr Prairieville LA 70769-3481 | |
(407) 447-7120 | |
Not Available |
Full Name | |
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Speciality | Internal Medicine |
Location | 17123 Commerce Centre Dr, Prairieville, Louisiana |
Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING PROFESSIONAL) |
Authorized Official Contact | 4074477120 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (305) 500-2000 | 17123 Commerce Centre Dr Prairieville LA 70769-3481 Ph: (407) 447-7120 |
NPI Number | 1518737766 |
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Provider Enumeration Date | 01/08/2024 |
Last Update Date | 08/22/2024 |
Identifier | Type | State | Issuer |
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1518737766 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
208D00000X | General Practice | (* (Not Available)) | Secondary |
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