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Organization
GEORGE IDICULLA MD,PA
Active
Organization
GEORGE IDICULLA MD,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE A IDICULLA M.D (PRESIDENT)
(321) 638-0888
Entity
Organization
Contact information
Practice address
1029 FLORIDA AVE S, ROCKLEDGE, FL 32955-2160
(321) 638-0888
Mailing address
1029 FLORIDA AVE S, ROCKLEDGE, FL 32955-2160
(321) 638-0888
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0066869
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376630600
—
FL
Enumeration date
02/08/2012
Last updated
07/30/2013
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