Provider Demographics
NPI:1205599453
Name:THE MD TELEMEDICINE NETWORK PLLC
Entity type:Organization
Organization Name:THE MD TELEMEDICINE NETWORK PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-608-4363
Mailing Address - Street 1:6515 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4008
Mailing Address - Country:US
Mailing Address - Phone:305-343-0604
Mailing Address - Fax:
Practice Address - Street 1:6515 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4008
Practice Address - Country:US
Practice Address - Phone:305-343-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty