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Organization
MCIC PHYSICIANS IPA GROUP, INC
Active
Organization
MCIC PHYSICIANS IPA GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY FOLLIARD IPA (MANAGER)
(786) 554-1151
Entity
Organization
Contact information
Practice address
40 EXCHANGE PL, 701, NEW YORK, NY 10005-2701
(786) 554-1151
(786) 331-9660
Mailing address
1825 PONCE DE LEON BLVD, 500, CORAL GABLES, FL 33134-4418
(786) 554-1151
(786) 331-9660
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Enumeration date
11/01/2016
Last updated
11/01/2016
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