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Organization
M & M MEDICAL CLINIC
Active
Organization
M & M MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MULUKEN D FREW MD (OWNER)
(813) 872-2777
Entity
Organization
Contact information
Practice address
1911 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL 33607-6509
(813) 872-2777
(813) 872-2775
Mailing address
PO BOX 441, SOUTH HILL, VA 23970-0441
(434) 447-8580
(434) 447-8538
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME88205
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35102
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/10/2008
Last updated
01/10/2008
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