Provider Demographics
NPI:1265711139
Name:DIABETES AND ENDOCRINE CLINIC PLLC
Entity type:Organization
Organization Name:DIABETES AND ENDOCRINE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIEF
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-460-7090
Mailing Address - Street 1:155 CRYSTAL BEACH DR STE 137C
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3588
Mailing Address - Country:US
Mailing Address - Phone:850-460-7090
Mailing Address - Fax:850-460-7093
Practice Address - Street 1:155 CRYSTAL BEACH DR STE 137C
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-3588
Practice Address - Country:US
Practice Address - Phone:850-460-7090
Practice Address - Fax:850-460-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92200207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03472OtherBCBS
FL276-100-900Medicaid
FL03472OtherBCBS
FLU8338ZMedicare PIN
FLU8338YMedicare PIN