| Pro Health Heritage Square Llc | |
|
901 E Oak St Suite A Kissimmee FL 34744-5837 | |
| (561) 843-7720 | |
| Not Available |
| Full Name | Pro Health Heritage Square Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 901 E Oak St, Kissimmee, Florida |
| Authorized Official Name and Position | Joseph J. Dicapua (MGRM) |
| Authorized Official Contact | 5618437720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pro Health Heritage Square Llc 2301 Nw 33rd Ct Suite 11 Pompano Beach FL 33069-1000 Ph: (954) 586-8058 | Pro Health Heritage Square Llc 901 E Oak St Suite A Kissimmee FL 34744-5837 Ph: (561) 843-7720 |
| NPI Number | 1801132386 |
|---|---|
| Provider Enumeration Date | 01/02/2013 |
| Last Update Date | 04/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801132386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0069080 (Florida) | Primary |
| 207RP1001X | Internal Medicine - Pulmonary Disease | ME19806 (Florida) | Secondary |
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