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Organization

NEUROLOGIC CONSULTANTS, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JULLIUS ILAO ANCHETA MD (PRESIDENT/PHYSICIAN)
(941) 412-1208
Entity
Organization

Contact information

Practice address
517 RIVIERA ST, SUITE A, VENICE, FL 34285-2827
(941) 412-1208
(941) 412-1248
Mailing address
517 RIVIERA ST, SUITE A, VENICE, FL 34285-2827
(941) 412-1208
(941) 412-1248

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME80512
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
264553000
FL
01
58680
BCBS
FL
Enumeration date
07/22/2005
Last updated
11/23/2009
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