Provider Demographics
NPI:1063667996
Name:ENDOCRINOLOGY AND DIABETES CONSULTANTS
Entity Type:Organization
Organization Name:ENDOCRINOLOGY AND DIABETES CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GULNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:561-964-1411
Mailing Address - Street 1:4915 S CONGRESS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4734
Mailing Address - Country:US
Mailing Address - Phone:561-964-1411
Mailing Address - Fax:561-964-3039
Practice Address - Street 1:4915 S CONGRESS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4734
Practice Address - Country:US
Practice Address - Phone:561-964-1411
Practice Address - Fax:561-964-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL07717174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty