# MIGUN OF THE TREASURE COAST L.L.C.

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

## Provider details

- **NPI number:** 1154456622
- **Authorized official:** MR. JACK RUSSELL (OWNER)
- **Authorized official phone:** (248) 921-6659

## Contact information

- **Practice address:** 2311 NW FEDERAL HWY, STUART, FL 34994-9311
- **Practice address phone:** (248) 921-6659
- **Practice address fax:** (772) 692-2384
- **Mailing address:** 2311 N W FEDERAL HIGHWAY, STUART, FL 34994
- **Mailing address phone:** (248) 921-6659
- **Mailing address fax:** (772) 692-2384

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | FL | Yes |

## Other

- **Enumeration date:** 02/23/2007
- **Last updated:** 07/21/2022