Provider Demographics
NPI:1538150826
Name:INTERNAL MEDICINE CONSULTANTS OF SAINT LUCIE COUNTY LLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE CONSULTANTS OF SAINT LUCIE COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAHEED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-464-0033
Mailing Address - Street 1:2401 FRIST BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4839
Mailing Address - Country:US
Mailing Address - Phone:772-464-0033
Mailing Address - Fax:772-467-1150
Practice Address - Street 1:2401 FRIST BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4839
Practice Address - Country:US
Practice Address - Phone:772-464-0033
Practice Address - Fax:772-467-1150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANUM CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-04
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378187900Medicaid
FLD56775Medicare UPIN
FL378187900Medicaid