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Organization
SUPERIOR PHYSICIAN GROUP
Active
Organization
SUPERIOR PHYSICIAN GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RENII MODISETTE (OPERATIONS MANAGER)
(813) 365-5680
Entity
Organization
Contact information
Practice address
10730 N 56TH ST STE 209, TEMPLE TERRACE, FL 33617
(813) 365-5680
Mailing address
10730 N 56TH ST STE 209, TEMPLE TERRACE, FL 33617-3611
(813) 365-5680
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
05/18/2018
Last updated
05/22/2018
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