Provider Demographics
NPI:1750589487
Name:MC MEDICAL ASSOCIATES PA
Entity type:Organization
Organization Name:MC MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:CANDELORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-823-7829
Mailing Address - Street 1:1519 SE 47TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9637
Mailing Address - Country:US
Mailing Address - Phone:239-823-7829
Mailing Address - Fax:
Practice Address - Street 1:1519 SE 47TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9637
Practice Address - Country:US
Practice Address - Phone:239-823-7829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty