| Glory Medical Center & Weight Loss Clinic | |
|
3651b W Waters Ave Tampa FL 33614-2783 | |
| (813) 932-9798 | |
| (813) 935-5178 |
| Full Name | Glory Medical Center & Weight Loss Clinic |
|---|---|
| Speciality | Internal Medicine - Geriatric Medicine |
| Location | 3651b W Waters Ave, Tampa, Florida |
| Authorized Official Name and Position | David Omotayo Ikudayisi (PRESIDENT/OWNER) |
| Authorized Official Contact | 8139329798 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glory Medical Center & Weight Loss Clinic Po Box 272450 Tampa FL 33688-2450 Ph: () - | Glory Medical Center & Weight Loss Clinic 3651b W Waters Ave Tampa FL 33614-2783 Ph: (813) 932-9798 |
| NPI Number | 1801892963 |
|---|---|
| Provider Enumeration Date | 06/23/2005 |
| Last Update Date | 10/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801892963 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME 87841 (Florida) | Secondary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | ME 87841 (Florida) | Primary |
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