Organization
EXPRESS CARE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLEKSANDR V ONUSHKO PHD (PRESIDENT)
(407) 475-3367
Entity
Organization
Contact information
Practice address
2650 W STATE ROAD 434, LONGWOOD, FL 32779-4815
(407) 475-3366
(407) 475-3367
Mailing address
2650 STATE ROAD 434, LONGWOOD, FL 32779
(407) 475-3366
(407) 475-3367
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
2083S0010X
Sports Medicine (Preventive Medicine) Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
FL
261QR0200X
Radiology Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
12/26/2013
Last updated
10/03/2014
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