Organization
AEGLE GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL JOHN MACLAREN MHHA (PRESIDENT)
(850) 250-5757
Entity
Organization
Contact information
Practice address
3003 S HIGHWAY 77 STE F, LYNN HAVEN, FL 32444-5627
(850) 250-5757
Mailing address
3003 S HIGHWAY 77 STE F, LYNN HAVEN, FL 32444-5627
(850) 250-5757
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
710189
—
FL
Enumeration date
04/30/2018
Last updated
10/29/2019
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