# NORTHERN MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134567613
- **Authorized official:** DANIIL SUPISHCHEV (OWNER)
- **Authorized official phone:** (941) 257-4763

## Contact information

- **Practice address:** 12450 TAMIAMI TRL S, SUITE E, NORTH PORT, FL 34287-1473
- **Practice address phone:** (941) 257-4763
- **Practice address fax:** (941) 257-4766
- **Mailing address:** 12450 TAMIAMI TRL S, SUITE E, NORTH PORT, FL 34287-1473
- **Mailing address phone:** (941) 257-4763
- **Mailing address fax:** (941) 257-4766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/06/2013
- **Last updated:** 10/10/2013