Provider Demographics
NPI:1346095254
Name:FLOWER CITY MEDICAL GROUP
Entity Type:Organization
Organization Name:FLOWER CITY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-733-5822
Mailing Address - Street 1:1815 S CLINTON AVE STE 620
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5723
Mailing Address - Country:US
Mailing Address - Phone:585-319-5354
Mailing Address - Fax:833-450-5339
Practice Address - Street 1:1815 S CLINTON AVE STE 620
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5723
Practice Address - Country:US
Practice Address - Phone:585-319-5354
Practice Address - Fax:833-450-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty