Provider Demographics
NPI:1639764871
Name:CERTMEDICALS WALK IN CLINIC AND WOUND CARE PLLC
Entity Type:Organization
Organization Name:CERTMEDICALS WALK IN CLINIC AND WOUND CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDEPATRICKS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ONYEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-926-3649
Mailing Address - Street 1:917 RINEHART RD STE 2041
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4806
Mailing Address - Country:US
Mailing Address - Phone:321-926-3649
Mailing Address - Fax:
Practice Address - Street 1:917 RINEHART RD STE 2041
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4806
Practice Address - Country:US
Practice Address - Phone:321-926-3649
Practice Address - Fax:321-926-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty