Provider Demographics
NPI:1992045140
Name:COMPREHENSIVE MEDICAL CARE OF THE TREASURE COAST, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL CARE OF THE TREASURE COAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OPERATING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELIKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-678-9664
Mailing Address - Street 1:6658 SE WOODMILL POND LN
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8710
Mailing Address - Country:US
Mailing Address - Phone:772-678-9664
Mailing Address - Fax:772-266-4601
Practice Address - Street 1:6658 SE WOODMILL POND LN
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8710
Practice Address - Country:US
Practice Address - Phone:772-678-9664
Practice Address - Fax:772-266-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBX334ZMedicare UPIN