Organization
NORTHERN MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIIL SUPISHCHEV (OWNER)
(941) 257-4763
Entity
Organization
Contact information
Practice address
12450 TAMIAMI TRL S, SUITE E, NORTH PORT, FL 34287-1473
(941) 257-4763
(941) 257-4766
Mailing address
12450 TAMIAMI TRL S, SUITE E, NORTH PORT, FL 34287-1473
(941) 257-4763
(941) 257-4766
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
06/06/2013
Last updated
10/10/2013
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