Provider Demographics
NPI:1720016744
Name:TREASURE COAST MEDICAL GROUP, PA
Entity Type:Organization
Organization Name:TREASURE COAST MEDICAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARJIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-461-0915
Mailing Address - Street 1:2100 NEBRASKA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950
Mailing Address - Country:US
Mailing Address - Phone:772-461-0915
Mailing Address - Fax:772-461-3825
Practice Address - Street 1:2100 NEBRASKA AVE.
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4831
Practice Address - Country:US
Practice Address - Phone:772-461-0915
Practice Address - Fax:772-461-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCI1218OtherRAIL ROAD MEDICARE
FLCI1218OtherRAIL ROAD MEDICARE
FLK180Medicare PIN