Provider Demographics
NPI:1235656786
Name:MD HEALTHNET MSO, LLC
Entity Type:Organization
Organization Name:MD HEALTHNET MSO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DI CAPUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-843-7720
Mailing Address - Street 1:2730 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5726
Mailing Address - Country:US
Mailing Address - Phone:954-586-8058
Mailing Address - Fax:754-222-6417
Practice Address - Street 1:2730 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5726
Practice Address - Country:US
Practice Address - Phone:954-586-8058
Practice Address - Fax:754-222-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty