Organization
PHYSICIAN BUSINESS ALLIANCE INC
Active
Other names
SPORTS MEDICINE INSTITUTE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN DONALD NOWICKI MD (PRESIDENT)
(352) 242-0404
Entity
Organization
Contact information
Practice address
2020 OAKLEY SEAVER DR, CLERMONT, FL 34711
(352) 242-0404
(352) 242-0877
Mailing address
2020 OAKLEY SEAVER DR, CLERMONT, FL 34711-1902
(352) 242-0404
(352) 242-0877
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33191
BC/BS FL
FL
Enumeration date
03/20/2006
Last updated
03/16/2017
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