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5991 Chester Ave Ste 211 Jacksonville FL 32217-2245 | |
| (904) 517-1400 | |
| (800) 431-0524 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 5991 Chester Ave Ste 211, Jacksonville, Florida |
| Authorized Official Name and Position | Dastagir Khan (MANAGING MEMBER) |
| Authorized Official Contact | 9049557190 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 551698 Jacksonville FL 32255-1698 Ph: (904) 276-6903 | 5991 Chester Ave Ste 211 Jacksonville FL 32217-2245 Ph: (904) 517-1400 |
| NPI Number | 1245489038 |
|---|---|
| Provider Enumeration Date | 09/16/2008 |
| Last Update Date | 03/31/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245489038 | NPI | - | NPPES |
| 000767800 | Medicaid | FL | |
| 99966 | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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