# BICOL MD PA

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

## Provider details

- **NPI number:** 1659762235
- **Authorized official:** MITCHELL SCHUSTER M.D. (MEDICAL DOCTOR)
- **Authorized official phone:** (561) 368-5558

## Contact information

- **Practice address:** 951 NW 13TH ST STE 3E, BOCA RATON, FL 33486-2337
- **Practice address phone:** (561) 368-5558
- **Practice address fax:** (561) 368-7907
- **Mailing address:** 951 NW 13TH ST STE 3E, BOCA RATON, FL 33486-2337

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | ME79854 | FL | Yes |

## Other

- **Enumeration date:** 02/18/2015
- **Last updated:** 02/18/2015