# IMMOKALEE FAMILY DOCTOR'S CLINIC, LLC

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

## Provider details

- **NPI number:** 1801157839
- **Authorized official:** ANDREA KEPPEL MA (OFFICE MANAGER)
- **Authorized official phone:** (239) 657-2779

## Contact information

- **Practice address:** 555 N 15TH ST UNIT A, IMMOKALEE, FL 34142-2824
- **Practice address phone:** (239) 657-2779
- **Practice address fax:** (239) 657-3335
- **Mailing address:** 555 N 15TH ST UNIT A, IMMOKALEE, FL 34142-2824
- **Mailing address phone:** (239) 657-2779
- **Mailing address fax:** (239) 657-3335

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | ME42490 | FL | Yes |

## Other

- **Enumeration date:** 06/06/2012
- **Last updated:** 04/25/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 113836500 | — | FL |