# MCIC PHYSICIANS IPA GROUP, INC

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

## Provider details

- **NPI number:** 1376095802
- **Authorized official:** TRACY FOLLIARD IPA (MANAGER)
- **Authorized official phone:** (786) 554-1151

## Contact information

- **Practice address:** 40 EXCHANGE PL, 701, NEW YORK, NY 10005-2701
- **Practice address phone:** (786) 554-1151
- **Practice address fax:** (786) 331-9660
- **Mailing address:** 1825 PONCE DE LEON BLVD, 500, CORAL GABLES, FL 33134-4418
- **Mailing address phone:** (786) 554-1151
- **Mailing address fax:** (786) 331-9660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/01/2016
- **Last updated:** 11/01/2016